Are you considering having your breast implants removed? Did you know explant surgery is more expensive than breast augmentation surgery? There are many reasons patients opt to remove their breast implants. Nevertheless, whatever the reason, you’re probably wondering if the explant procedure is covered by insurance.

Will Insurance Cover the Cost of Removing Breast Implants?

It depends is the most straightforward answer because insurance policies are individualized, making them specific to each person’s health needs. Plus, no two companies carry the same guidelines for plastic surgery procedures. Breast augmentation and explant surgery, like most invasive cosmetic surgeries, are deemed voluntary. Speaking with your provider and understanding which benefits are covered will let you know if you can get all or some of it met. Look in the benefits section of your policy. On the plus side, you just might qualify for a bit of insurance coverage for your breast removal.

As stated by the National Center for Health Research, insurance companies do care about breast augmentation surgeries and why you got them in the first place. The Center says, “If your implants were put in after a mastectomy and your doctor believes that removing your implants is “medically necessary,” then your health insurance is legally obligated to cover your breast implant removal under the Women’s Health and Cancer Rights Act of 1998 (WHCRA).”

How Will I Know if My Procedure is Covered?

Start with asking yourself if you got breast augmentation for aesthetics reasons or because it was medically necessary. If you answer for vanity, it is likely not going to be covered. If you answer medically essential because of implant failure due to a tear or rupture, capsulectomy, or a critical capsular contracture, then it’s possible. Keeping in mind, the insurance company will only cover removing the implants. Procedures addressing the now sagging and loose skin like a breast lift, breast reconstruction, or fat transfer to the chest or replacing the implant as opposed to removing it is presumably not an option. Neither is stress or other medical side effects and illnesses from getting breast implants. And just because you and your doctor view your situation as medically necessary doesn’t mean your health provider will see it the same way.

The best approach is to be able to pay for your procedure yourself in case of denial after you’ve begun the process of preparing for explant surgery. There is blood work, X-rays, and additional pre-op testing to think about too. Nobody wants to be blindsided with extra fees you thought were covered, such as your board-certified physician, the medical facility, anesthesiologist, and medications. Inquire about financing options (as another back up) with the plastic surgery office you choose to perform your operation.

What’s Next After Speaking with My Health Insurance Company?

The reasons for explant surgery are many and vary from person to person. Talking to your health insurance company representative to fully understand if they can or will cover your costs for breast removal surgery is a move in the right direction, along with contacting a board-certified plastic surgeon’s office specializing in the procedures you need, even if you are still seeking answers.

Now that you have more information about the financial and insurance obligations, contact Barrett Plastic Surgery at 310-598-2648 to schedule a consultation. If you’re more content speaking with our team from the comfort of your home, we provide virtual surgical consultations.

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