The Ultimate Guide to Breast Reconstruction Insurance Questions

There are a lot of questions out there regarding insurance costs for reconstructive surgery.

Because breast reconstruction surgery can be expensive, it’s important that you know as much as you can about whether the procedure will be affordable for you, and what your insurance coverage options are.

Keep reading to check out some of the most common breast reconstruction insurance questions we receive.

Why Won’t Insurance Pay for Reconstruction?

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Question: I don’t understand why insurance company doesn’t pay for reconstruction if you’ve had a lumpectomy. With radiation, your breasts shrink a lot and you are all out of proportion. I finally did get them to pay for prosthesis and bra.

Answer: That’s not always the case with a lumpectomy. If the surgery results in a significant defect or radiation negatively impacts the tissue, most times we can submit your case to your insurance company along with photos of the affected area, and they will indeed cover a reconstruction surgery for you.

Read the full post here.

I’m Looking for a Plastic Surgeon That Specializes in Microvascular Breast Reconstruction. Are You in My Insurance Network, and Do I Have to Make a Huge Down Payment before Surgery?

Question: I am looking for a p.s. who specializes in microvas. breast recon. I had dcis in 2014 lumpectomy with 6 weeks rads followed by bilat mast. 2016 with immed. recon with expanders then implants in March. Then I got a serious infection in the left (rad) breast, had implant removed and refused to do have lat flap done.

I am thin and one PS said I might be able to do a body lift type or one where they take from my backside and use an implant on both sides. I do not want the implant I have now. It is subpec and is painful. Can someone help? I have anthem BC/BS and you are out of network.

I do not have 8500 to have this done at another location. My insurance is agreeable to a pay if it is in network. I can’t afford much out of pocket. We are low -middle class, but don’t qualify for help.

Answer: Hi, and thanks for your inquiry. Glad you found us – you’ve definitely found a team that specializes in microvascular breast reconstruction. Regarding your insurance, does your card have a little suitcase on the lower corner of your card? If so, we’re actually in network for your, utilizing the Blue Card program through our contract with BCBS of S.C.

Read the full post here.

Does Insurance Cover Breast Reconstruction for Poland Syndrome?

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Question: I was wondering what insurance would cover breast reconstructive surgery that’s due to having Poland Syndrome? My case I where I was born without having my right breast muscle and a smaller areola.

Answer: The good news is that we’ve been able to get breast reconstruction for Poland syndrome covered for past patients and certainly know how to navigate the process to make that happen for you.

Read the full post here.

Will My Insurance Cover a Prophylactic Mastectomy If I’ve Had Gene Testing?

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Question: I did the gene testing in February; tested positive for BRCA 2. I want to go full steam ahead and be proactive with prophylactic mastectomy. I am a 31-year-old single mom.

However, in regards to insurance, I am in a pickle. I just switched jobs and will be obtaining new/different insurance with a new company. Will the new insurance I am obtaining most be okay with the gene testing from the prior company and proceed to pay for the mastectomy/reconstruction? I can provide all the results and positive test results as well to them to suffice.

Answer: Most insurances do pay for prophylactic mastectomies when you have a gene conferring increased risk. While I cannot tell you with certainty, the companies that offer the tests are pretty standardized, and there is no logical reason not to accept the results of a prior test.

Read the full post here.

How Much Will Insurance Cover?

Question: Hi, I am 19 years old and 13 months ago I had a benign lump removed from my right breast. Since then, my right breast has increased in size significantly but my left one has not. My left breast is a full size smaller than my right breast and I’m very self-conscious about it.

I want to get a procedure done that will even them out. I’m just having a hard time finding the right doctor to do it, and I’m unsure how much the insurance will cover. If you could help me with the insurance policies and what your surgeons could do for me, I would greatly appreciate it. Thank you so much.

Answer:  Thanks for your question!

It is difficult to sort out exactly what is going on and what would need to be done based on your brief description. While your insurance company may not be obligated to cover any treatment without the diagnosis of breast cancer, that does not automatically mean that they won’t.

Read the full post here.

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