This week, Gail Lanter, CPC of The Center for Natural Breast Reconstruction answers your question.
Question: I was wondering what insurance would cover breast reconstructive surgery that’s due to having Poland Sydrome? My case I where I was born with out having my right breast muscle and a smaller areola.
Answer: I would be happy to check into your specific insurance company medical policy if you want to share that information. I’ll just need basic demographic information (I’ve attached a form you can use to provide what I’ll need) and a copy of the front and back of your insurance card. I’m not sure from the phrasing of your question if you currently have coverage or if you are researching to find out which insurance would offer coverage, could you clarify? I can help either case.
The good news is that we’ve been able to get breast reconstruction for Poland’s syndrome covered for past patients and certainly know how to navigate the process to make that happen for you. Feel free to give me a call or send info via e-mail. I’m always happy to help – and I do love a challenge !!) Have a great day and I look forward to your reply.
Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!
yes in California in 2019 I know it is covered. I could be wrong but I don’t think there is any way to NOT cover it. The mandated health benefit states that it is reconstructive surgery. since it is a congenital birth defect which is abnormal structure and the reconstructive surgery covers abnormal structure from congenital birth defects for EITHER to improve appearance OR to improve function. I could be wrong but I am fighting it and all insurance policies I have read in California do qualify for coverage. important because then other surgeries needed in the future due to Poland Syndrome will be covered.
United Health Care medical review says it is covered for Poland Syndrome. All companies will reject reject reject, but fight it is covered. Cosmetic surgery is improving appearance on a NORMAL structure. The key words in the definitions are Normal vsAbnormal and Reconstructive Vs cosmetic