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Will My Breast Augmentation Be Covered By Insurance?

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If you have decided to have breast augmentation surgery, there are several things to consider, such as which type of breast implant and size will work best for you, plus finding the right plastic surgeon in your area. Another important element is finding out whether your insurance will cover your breast augmentation procedure. It's essential to have a clear understanding of the costs involved before having any plastic surgery. Typically, breast augmentation is considered elective surgery and is not covered by insurance. However, breast reconstruction surgery that involves breast implants may be fully or partially covered. It is wise to educate yourself about the details of your plastic surgery and insurance coverage before scheduling your procedure.

Dual board-certified aesthetic plastic surgeon Dr. Nana Mizuguchi and his professional staff at Mizuguchi Plastic Surgery in Louisville, KY want you to be prepared. Here is an in-depth look at plastic surgery and insurance, the right questions to ask your insurance provider, and what you need to know so you are better prepared for the financial aspect of your breast augmentation procedure.

What is considered cosmetic vs. medically needed?

When it comes to plastic surgery, what is deemed cosmetic or medically necessary is determined by the insurance company and may even change over time. Reasons for insurance plans changing your coverage:

  • The type of insurance a patient has can change with newly implemented policies or a new insurance provider

  • Evolution of new medical treatments or new procedures

  • Medical research and how it relates to patient needs can affect insurance policies

Most insurance providers follow surgical definitions provided by the American Society of Plastic Surgeons (ASPS) and the American Medical Association (AMA) to distinguish between cosmetic surgery and medically necessary (or reconstructive) surgery. In other words, what they determine to be medically necessary or purely elective. For example, cosmetic surgery is the conventional classification for breast augmentation, as breast implants will enhance and reshape the body to improve a patient's appearance. Reconstructive surgery is performed on abnormalities in the breasts due to trauma, disease, infection, tumors, or developmental conditions. When breast implants are necessary to improve the function of the breast or give a patient a healthy appearance, insurance providers may fully or partially cover the breast augmentation procedure.

Will insurance cover my breast implants?

In the majority of cases, patients are responsible for paying for their breast augmentation surgery, as breast implants to enhance or alter a patient's appearance for solely cosmetic reasons are typically not covered. Exceptions are dependent on the reason a patient is getting breast implants in regard to insurance coverage. In general, a patient who needs breast reconstruction with a plastic surgeon like Dr. Mizuguchi allows for insurance to partially or fully pay for the surgery. Breast implants involving reconstruction due to a medical condition like breast cancer, Poland's syndrome, trauma, or an infection is most likely covered by most insurance plans. Patients considering breast augmentation should check with their insurance provider to determine their coverage.

What important questions should I ask my insurance provider?

Before moving forward with your breast augmentation surgery, it is essential to talk to your insurance provider. Here are five questions to ask your health insurance provider:

  1. Will any of the costs for my breast augmentation procedure be covered?

  2. If I have any complications related to my breast implants, will the necessary treatment be covered?

  3. Will having breast implants affect my insurance rates or coverage if I develop breast problems later?

  4. Will diagnostic tests like MRIs or additional mammogram images be covered after getting breast implants?

  5. Will my breast augmentation surgery affect my health insurance coverage or rates?

In cases where a patient is getting breast implants due to a reconstruction or reduction procedure, insurance may partially or fully pay for the procedure. Breast reduction is one of the rare circumstances that helps women cosmetically change the appearance of their breasts but is covered by most insurance plans. Patients with large breasts endure certain physical limitations and health issues such as back or neck problems. Much like breast reconstruction surgery, a breast reduction can be considered a medical necessity for some women.

If you are considering plastic surgery, it's important to do your homework and determine your financial responsibility. During your consultation, verify the cost of your breast augmentation, including your surgeon's fee, anesthesia, and any surgery center costs. The professional, experienced staff at Mizuguchi Plastic Surgery is available to offer assistance to clients in the Greater Louisville area who have insurance or financing questions.

Schedule your consultation at Mizuguchi Plastic Surgery

If you are considering breast augmentation, we invite you to schedule a consultation with Dr. Nana Mizuguchi in Louisville, KY. Dr. Mizuguchi and his team at Mizuguchi Plastic Surgery will answer all your questions about your surgery, and can give you information about financing options if needed. Start your journey toward a fuller, shapelier silhouette today.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.