Will my health insurance cover breast surgery?

When researching breast surgery procedures, many prospective patients become concerned with the costs associated with surgery. Will health insurance cover the procedure? The answer depends on the type of breast surgery and your reasons for undergoing the procedure.

In general, cosmetic surgery is not covered by health insurance. This normally includes such elective procedures as breast augmentation, breast lifts, and breast reduction. However, in some cases breast surgery is covered by health insurance. These are procedures that are deemed medically necessary or considered reconstructive rather than purely cosmetic.

Breast cancer related surgery

One example is breast reconstruction surgery following a mastectomy to treat breast cancer. In this case, insurance carriers are now required by law to cover breast reconstruction if they also cover mastectomy surgery. Another example is breast reduction surgery when overly large breasts are causing significant back and neck pain or other health problems.

In short, if the purpose of the breast surgery is to improve your appearance, it is probably not a covered expense. If, however, the procedure will correct or alleviate a medical concern, it may be covered, either in part or in full. If you're not sure whether your health insurance will cover the type of breast surgery you plan to undergo, consult with the insurance company before scheduling the surgical procedure. Health plans and individual circumstances vary widely; be sure that you have a definite answer one way or the other before undergoing surgery.

Be aware of restrictions and requirements

While some breast surgery procedures are covered by insurance, there may be details that you need to be aware of before the surgery. There may be deductibles or co-pays that apply specifically to these types of breast surgeries, or restrictions on the surgical methods used during the procedure. You should be aware of all of the insurance requirements before scheduling your procedure.

If you opt to undergo breast surgery and it is not covered by your insurance, you'll be expected to pay the costs – averaging $3,816, according to the American Society of Plastic Surgeons – out of pocket. Many plastic surgeons offer flexible payment plans and other financing options for those whose procedures are not covered by health insurance. If cost is a concern for you and your procedure is not covered by your insurance carrier, be sure to inquire about your payment options during the consultation visit.

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