Having breast reconstruction surgery can impact a woman’s life in an incredibly positive way, and it can improve her body image drastically.
Women will schedule a breast augmentation for a variety of reasons: some women have had mastectomies due to cancer while others may just wish to have a fuller bust than they’ve had for most of their lives.
No matter the reason, a breast augmentation can really improve the quality of life a woman experiences.
Like any surgery, this procedure can be incredibly expensive and not everyone will have the money to fund it out of their own pocket. So, it begs the question: does insurance pay for a breast augmentation?
The short answer is sometimes, depending on the situation.
When Does Insurance Cover Breast Augmentation?
For women who want to enhance their breast size for cosmetic reasons insurance will almost never cover the cost of having a breast augmentation.
However, for women who have gone through mastectomies due to cancer then insurance will cover some of the costs of having this procedure done.
How Much Does Breast Augmentation Cost?
In most cases, women will pay $6,550 to have a breast augmentation. This cost will include surgeon’s fees, operating room time and anesthesia.
For women who want this done due to cosmetic reasons, they will not get any insurance coverage for paying and will need to pay the entire cost out of pocket.
Some surgeons may have payment plans that make it easier to have the surgery done earlier, but that will be something to discuss with your surgeon at the time of booking.
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Talking To Your Insurance Company Before The Procedure
Even if you know that your procedure for breast augmentation won’t be covered, there are still questions you need to be asking your insurance company as this procedure could have further reaching implications.
Will Getting Breast Implants Affect The Coverage Or Rates You Receive?
In some cases, having breast implants will cause your insurance company to increase your rates or decrease your coverage because there can be some complications that come with having breast implants.
If there are complications related to breast implants, is that treatment covered?
When you have a procedure that can cause other health implications, some insurance companies won’t cover further complications that are a direct result of the procedure.
For example, if you need emergency surgery because of an infection from having a breast augmentation will your insurance cover your hospital stay and subsequent care? If the answer is no, can you risk having a complication and that you can pay for it out of pocket?
If You Develop Breast Cancer, And Have Implants, Are You Covered For Treatment?
When someone is diagnosed with breast cancer, and they have private insurance, there is most often coverage available for treatment.
In some cases, though, if the diagnosis of an illness can be directly related to a person’s choice of lifestyle of activities, insurance may be less likely to cover that treatment.
There have been some women who have developed breast cancer after getting implants, or having them for years, but it doesn’t mean that the two are related.
However, having breast implants are not considered necessary so your insurance company may determine that you do not qualify for coverage with cancer treatment when you’ve had implants.
Part of the Affordable Care Act does prevent insurance companies from denying people care and coverage due to pre-existing conditions, they can legally charge incredibly high premiums (making it almost impossible to afford), limit your coverage (so you cannot get coverage for treatment for breast-related issues), or they could refused to renew your policy when it comes due.
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Are Diagnostic Tests Covered?
If you have breast implants and then need an MRI or mammogram, are those tests covered?
While there may not be any complications due to having the augmentation done, just having the implants could disqualify you from getting coverage for any subsequent diagnostic testing you need to have done.
The Additional Costs Of Breast Augmentation
While the actual cost of having the procedure is just over $6,500 there are some additional costs to having this done that many people may not be thinking of.
Additional Costs With Surgery
When you are booking with your surgeon you will want to make sure that you ask about all costs associated with the procedure. This could include medications you will need a prescription for to take home, hospital fees, and so on.
Some surgeons will give you an all in fee, that covers everything needed for that day while others may only tell you what their cost is and there will be a list of additional fees you need to pay for. It’s important to make sure you understand the complete cost of the procedure.
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Many women who have a breast augmentation will need a follow up surgery at some point. In some cases, it could be years before they need another surgery and may just simply want or need to reposition the implants as they can mover over time.
Some women have an allergic reaction to having the implant or want to adjust the positioning right away so they will need another surgery almost immediately.
Breast implants don’t last forever, so another surgery at some point will be needed – whether to adjust them, remove them or replace them with new ones – so if you are not covered by insurance now for a breast augmentation you likely won’t be covered in the future so you will need the funds to be able to pay for the additional surgeries.
Diagnostic Testing And Imaging
It is recommended that women who have breast implants get MRIs or ultrasounds every so often to make sure that the implants themselves haven’t ruptured.
These tests are only needed for women who have silicone breast implants, as if they have saline the risk is not the same. A single MRI can cost up to $2,000 in the US so if you have silicone implants you will need to get this done every three to five years. Do you have that kind of money to fund the imaging?
Further, implants can skew the results of a mammogram for some women, so there may be extra imaging required when having a mammogram to make sure that the results come back accurate.
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Does Insurance Cover Breast Implant Removal?
When it comes to removing your breast implants, you may run into some issues with coverage for the procedure to remove them.
Much like the reasoning for having the implants done matters to insurance companies, the reason why you want them removed will also matter.
For example, if your implants were put in as part of reconstruction after having a mastectomy and now your doctor believes it’s medically necessary to remove them then your insurance company has a legal obligation to cover the cost of removing them.
Now if your original reasoning for the breast augmentation was cosmetic, but now it’s medically necessary to remove them then your insurance may cover the explant surgery.
Why Would It Be Medically Necessary To Remove Breast Implants?
A patient can want to remove their breast implants for any number of reasons, but that doesn’t mean their reasoning is considered to be medically necessary.
There is a specific list of reasons that insurance companies would consider the explant surgery to be medically necessary
- An infection that won’t go away, and is not effectively treated by antibiotics
- Severe capsular contracture
- Ruptured silicone implant
- Chronic, increasing pain in a patient’s breast
- Breast-Implant Associated Anaplastic Large Cell Lymphoma – which is a cancer in a person’s immune system
There can be other complications that happen related to breast implants, but most insurance companies do not consider them to be medically necessary so they may not cover the explant procedure. If you want to be sure, you will need to contact your insurance company to determine what they cover for you.
Does Insurance Cover Other Cosmetic Procedures?
For a variety of reasons, people choose to have cosmetic procedures all the time. Whether it’s to maximize their self-esteem or correct an issue they have been living with for a long time, cosmetic procedures can have a very positive impact on many people’s lives.
One popular procedure is a Brazilian Butt Lift (or BBL). Since this procedure is not considered medically necessary, there are very few insurance companies who will actually cover the costs of it.
[PFor this reason, you will need to cover the costs out of pocket for a cosmetic procedure like this.
A BBL can help boost anyone’s self-image and make them feel better about their appearance, but insurance unfortunately won’t foot the bill for this one and you will need to pay for it yourself.
Some surgeons will offer packages and payment plans to make it more affordable for people to have the procedures they want, but you will need to talk to them about the total costs involved and make sure you know exactly what’s expected of you to pay on date of surgery.