Does Insurance Cover Breast Implant Removal Surgery?

While most women enjoy their breast implants for years, a small percentage may experience trouble with their implants, such as ruptures, capsular contracture, or breast implant illness (BII). In some cases, women decide that their breast implants just aren’t what they expected or wanted. No matter what the reason is for considering breast implant removal surgery, one of the big questions women ask is, “Will my insurance cover breast implant removal?” While most insurance does not cover cosmetic procedures, medically necessary breast implant removal is often an exception.

How Old Are Your Implants?

If you are looking at breast implant removal due to a problem with the implants, and your implants are relatively new, you may be covered by an implant warranty. All FDA-approved breast implants offer a warranty that covers the removal and replacement of implants under specific conditions and during a specific timeframe. If your implants are relatively new, check with your surgeon that performed your breast augmentation.

Is Breast Removal Medically Necessary?

If your warranty has expired, the only way to possibly have your breast implant removal covered by insurance is to qualify for a medically necessary condition. In general, insurance companies will cover breast implant removal when you have medical evidence of a recognized medical diagnosis, such as capsular contracture, implant rupture, or a rare cancer known as associated anaplastic large-cell lymphoma (BIA-ALCL). At this time, breast implant illness (BII) is not typically covered by insurance.

Most national insurance companies will cover breast implant removal if your removal meets their list of medically necessary reasons.

Contact Your Insurance Company 

Even if you do not think that your insurance will cover your breast implant removal, it is best to contact your insurance company to find out for sure. Ask your surgeon for the CPT codes for your treatment and provide them to your insurance company. They can then check to see what they will and will not cover. This way you can avoid any potential surprises and bills.

If you are experiencing problems with your breast implants that you think may be serious or you are just not happy with them and are considering implant removal, Dr. Drew Davis and his team can help. To learn more about breast implant removal, contact our office today at (916) 318-5770 to schedule a consultation.