Q: My wife have stated to me that she would like to have breast augmentation. My question, is any type of plastic surgery covered under health insurance plans. I not sure if we could afford something like this. What are my options for plastic surgery procedures. Thank you.
A: It is not rare that I get a request from a prospective patient inquiring about whether a breast augmentation would be covered by their health insurance. This question points to a fundamental misunderstanding of what one’s health insurance is for and the differences between cosmetic and reconstructive plastic surgery. Health insurance is intended to pay for preventative and treatment care for medically necessary conditions. When it comes to the breast such medically necessary surgery would include breast biopsies, lumpectomies, mastectomies and any form of breast reconstruction that these procedures have caused. Breast conditions caused by underdevelopment (small breasts) or breast shape changes due to pregnancy or aging (breast sagging) are not medically necessary conditions. Therefore, rebuilding a damaged or partial or completely removed breast would be breast reconstruction and is medically necessary and paid for by health insurance. Increasing the size of the breast with implants or changing its shape by lift procedures are cosmetic changes and are never covered under one’s health insurance.
While it is understandable that one wants to have their insurance cover breast augmentation, that remains wishful thinking. At best, insurance will never pre-approve a breast augmentation. At worst, trying to do breast augmentation under insurance would be considered fraudulent.
Dr. Barry Eppley