6 Min Read:
Cosmetic breast surgeries, particularly breast lift procedures, are extremely popular among women seeking to enhance the contours of their upper body and improve their self-esteem. However, while plastic surgery is not usually covered, a question that still arises is whether insurance ever covers the costs of a breast lift. This comprehensive blog explores the nuances of insurance coverage for cosmetic breast surgery, with a focus on breast lift surgery.
What Is a Breast Lift?
Like their spirits, women usually prefer their breasts to be lifted and supported. Mastopexy (breast lift surgery) raises and reshapes sagging breasts, potentially alleviating physical discomfort and boosting confidence and self-esteem. This procedure removes excess skin, recontours the natural breast tissue, and repositions the nipple-areolar complex to a higher, more youthful position and size. Unlike breast augmentation, which involves inserting implants to increase breast size, a breast lift primarily focuses on improving the shape and firmness of the breasts.
When Does Insurance Cover Breast Lift Surgery?
Health insurance companies classify breast lift surgery as an elective cosmetic procedure, which means it is not generally covered by insurance. However, if a breast lift is deemed medically necessary, health insurance may cover some of the cost. Below are some important factors that can influence insurance approval for your breast lift surgery:
Medical Necessity
Insurance companies may cover a breast lift if the procedure is considered medically necessary rather than purely cosmetic. To establish medical necessity for a breast lift, patients may need to provide evidence of the following conditions:
- Severe Ptosis: If breast sagging is so severe that it causes physical discomfort, such as back, neck, or shoulder pain, rashes or skin irritation under the breasts, or difficulty with physical activities, insurance might cover the procedure. A breast lift is very similar to breast reduction surgery, and women with very large, sagging breasts can use this procedure to increase their chances of approval.
- Reconstructive Surgery: In cases where breast lift surgery is part of a broader reconstructive plan following a mastectomy or significant weight loss, insurance coverage is more likely; this is especially true if the breast lift is necessary to achieve symmetry or restore a normal appearance.
- Congenital Deformities: If a patient has a congenital breast deformity that affects their physical or emotional well-being, insurance companies may consider breast lift surgery to be a medically necessary corrective procedure.
Documentation and Medical Records
To secure insurance coverage for a breast lift, thorough documentation and medical records are crucial, including:
- A Physician’s Letter: Insurance companies usually require a detailed letter from the patient’s primary care physician or surgeon explaining the medical necessity of their breast lift procedure. This letter should outline the physical symptoms and any treatments tried previously.
- Photographs: Preoperative photographs documenting the degree of ptosis and any physical issues caused by the sagging breasts can strengthen the case for medical necessity.
- Medical History: Comprehensive medical records will also be required, detailing the patient’s history of symptoms, treatments, and the impact of breast ptosis on their quality of life.
How to Know if Your Breast Lift Qualifies for Insurance Coverage
If you believe your breast lift surgery might qualify for insurance coverage, here are five steps you should take:
- Consult a Board-Certified Plastic Surgeon: Consult with a board-certified plastic surgeon experienced with insurance-related cases. The surgeon can evaluate the severity of your condition, determine whether your situation might be considered medically necessary, and guide you through the documentation process.
- Gather Medical Evidence: Collect all relevant medical records, including documentation of symptoms such as pain, rashes, or physical limitations. Ensure your primary care physician and any specialists involved in your care provide detailed notes and letters of support.
- Submit a Pre-authorization Request: Work with your plastic surgeon’s office to submit a pre-authorization request to your insurance company. This request should include all supporting documentation, medical records, photographs, and letters from your healthcare providers.
- Follow Up With Your Insurance Company: Maintain open communication with your insurance company to track the status of your pre-authorization request. Be prepared to provide additional information and advocate for your case if necessary.
- Consider an Appeal: If your initial request is denied, you may be able to appeal this decision. Many insurance companies have an established process for appeals. Work with your surgeon and healthcare providers to gather additional evidence to support your appeal.
Navigating insurance coverage for cosmetic breast surgery, particularly breast lift surgery, can be challenging but not impossible. Understanding the distinction between cosmetic and medically necessary procedures is essential. By thoroughly documenting the medical necessity of your procedure, consulting with experienced healthcare providers, and being proactive with your insurance company, you can increase the likelihood of securing coverage. If your surgeon does not take insurance, his documentation for medical necessity is still critical if you plan on having the surgery and using the documentation after to submit to your insurance company. Be aware that due to differences in the insurance companies, how much they may reimburse you may not necessarily match the cost of your breast lift surgery.
Other Ways to Fund Your Breast Lift Surgery
If your insurance does not cover breast lift surgery, don’t worry. Other financial options for breast lift surgery are available. Many plastic surgery practices offer financing options, allowing patients to spread the cost over time.
Credit cards with a zero to low introductory APR can allow you to make payments with no interest for up to 18 months. In addition, companies like CareCredit® and ALPHAEON® provide healthcare financing options to make your breast lift more affordable.
When It Comes to Your Breast Lift, Don’t Go Bargain Hunting!
Breast lift surgery can significantly enhance a woman’s quality of life by improving physical appearance, alleviating physical discomfort, and boosting self-confidence. Whether or not insurance covers the procedure, the investment in health and well-being can be invaluable.
Whatever you do, you shouldn’t base your choice of a surgeon on price alone. A skilled, board-certified plastic surgeon can deliver the best results, lower your risk of complications, and help you avoid corrective surgery.
Quality Breast Lift Surgery With Financing in Newport Beach, CA
Dr. Keyian Z. Paydar is a highly respected board-certified plastic surgeon in Newport Beach, CA, with years of experience performing breast surgeries to provide the most beautiful results, whether a breast lift, augmentation, or a combination of both.Our surgeon’s meticulous attention to detail, advanced placement, and contouring techniques lead to ideal, youthful, and natural-looking outcomes. Call us today at 949-755-0575 or complete our online contact form to schedule your consultation with Dr. Paydar and learn more about your breast lift options.
