Episode 22: Is Breast Explant Surgery Covered by Insurance?

Besides choosing a qualified plastic surgeon, there are those who also take into consideration the costs of breast explant surgery. In fact, one of the questions we frequently get is whether breast explant surgery is covered by insurance.

Insurance coverage influences the decision-making process. Knowing whether or not such a surgery is covered by insurance helps individuals evaluate the costs and benefits before deciding if they are willing to proceed with the operation. In today’s episode, we’ll be talking about such insurance coverage and financial preparation.

Is breast explant surgery covered by insurance?

At present, it’s hard to get breast implant illness or breast explant surgery covered by insurance since there is still no International Classification of Disease 10th Revision (ICD-10) coding for such a procedure.

As an alternative, what we use for the ICD-10 Code is breast pain considering that it is still indicative of breast implant illness. Many patients suffering from breast implant illness have experienced breast pain, which is why we tend to associate breast pain with breast implant illness. In line with this, patients also suffer from capsular contracture or pain associated with the implant, which may be nerve pain or breast pain in general.

Everything is very costly! The patient has to pay for the facilities to be used and also for the surgeon, which is why many patients ask if these can be covered by insurance. The answer is yes; however, breast explant surgery can only be covered by insurance upon showing medical necessity.

We used to provide basic letters of medical necessity. However, it became sort of a problem for us because insurers would come back to us to really inquire about many things, which really complicated everything. That is why we gradually shifted to implementing a purely cash-based practice. And although it is rare, I had people who had self- administered plans able to get reimbursement from insurance.

How to prepare for the cost of the procedure?

We have pointed out how costly it is for patients to get breast implants and to undergo breast explant surgery. Surely, some of you may have started wondering how to prepare for the expenses.

We use PatientFi and Ally routinely, which are great companies that work with our patients to provide options for financing. We can also work and consult with your tax strategist and advisors if it is possible to have these written off of your taxes as medical expenses. Another recommendation is to get support and counselling from a financial advisor or other patient groups advocating for explants.

You can also check out our Holistic Accelerated Recovery Program (HARP) to get started. We offer supplements and services that would help you to learn more about breast implant illness and help prepare you for financial investments.