Are you wondering if your health insurance will cover the cost of removing your breast implants? Although contracts and rules differ, in general, the insurance company will look at the original purpose for the implants.
- If the implants were placed after a mastectomy and the doctor thinks they should be removed, “If the breast implant removal is deemed “medically essential,” health insurance is compelled to pay for it.
- If the original purpose of the breast implants was to enhance the appearance of healthy breasts, some health insurance companies will fund explant surgery if the services are deemed necessary “Others, however, will not consider it “medically necessary.”
What if my insurance provider says “cosmetic surgery issues” aren’t covered?
Don’t let yourself down. Almost all health insurance coverage exclude “cosmetic surgery” and “cosmetic surgery consequences,” but don’t give up. Many insurance make exceptions for issues from breast implants if they are deemed “medically required” or “reconstructive surgery” in certain instances.
Varied health insurance companies have different definitions for this, and it also differs by state.
Even if the doctor believes that removing the breast implants is medically required, the health insurance policy could refuse to pay if the policy’s definition of medically necessary differs from the doctor’s.
Most of the most generous health insurance coverage for breast implant removal are based on one of the following conditions:
- Baker III or Baker IV capsular contracture is caused by silicone or saline implants.
- Breast implants that need to be removed due to infection or BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma, an immune system disease).
- Rupture: If the implants have ruptured, proof is required. Implant ruptures are best measured with MRIs, however ultrasounds or mammograms may also be used. Mammography, on the other hand, can cause existing breast implants to shatter or leak, and it is not particularly accurate at identifying rupture, so it is best to avoid it.
- Breast implants are a “foreign body,” and most women’s bodies naturally respond by forming scar tissue around the implant inside the body to defend the body from this “foreign invader.” This is a natural occurrence. When the scar tissue around the implants tightens or hardens, it is referred to as capsular contracture. Breast implants made of saline or silicone can cause capsular contracture. It can make you feel a little uneasy or cause excruciating agony. The mildest form of capsular contracture is known as “Baker I” or “Baker II” (after Dr. Baker, who created the classifications), whereas the most severe is known as “Baker III” or “Baker IV.” Breasts that are Baker III or Baker IV are hard and/or painful. Baker III and/or Baker IV level capsular contracture is usually only considered a medically required reason for removal by insurance carriers.
- Chronic Breast Pain: Capsular contracture pain is frequently stated as grounds for insurance coverage of breast excision. Furthermore, if the implants are causing severe discomfort due to nerve damage or the weight of the implants, the insurance company may be able to cover the cost of removal.
Unfortunately, most insurance companies do not consider any autoimmune diseases/symptoms or anxiety related to the implants as indication that removing the implants is medically essential. Many women with those symptoms, however, also have other issues like leaky silicone implants or capsular contracture. Concentrate on the symptoms that the insurance company is interested in, rather than the ones that aren’t covered.
When the objective of the surgery is to remedy a medical condition, some insurance companies will consider breast implant removal “reconstructive surgery” rather than “cosmetic surgery” and thus medically required. This usually indicates Baker grade III or IV capsular contracture, as well as restricted movement that makes it difficult to perform simple actions like reaching over the head. If there are silicone lumps in the breast area that interfere with the identification of breast cancer, breast implant removal may be considered restorative.
When it’s time to approach the insurance company for coverage, Fox Valley Plastic Surgery writes the insurance company a letter explaining why breast implant removal is medically required. The emphasis is on complications that are more likely to be reimbursed by insurance (such as implant rupture or Baker III or IV capsular contracture), rather than symptoms that the insurance company will not pay (such as autoimmune symptoms).
How much does it cost to have a breast implant removed?
How much does it cost to have a breast implant removed? According to the American Society of Plastic Surgeons’ 2020 figures, the average cost of breast implant removal operation is $3,049. This is only a portion of the entire cost; it excludes anesthesia, operating room facilities, and other related costs.
Is an explant covered by insurance?
Breast implants can significantly improve a woman’s life. Breast implants are used by roughly 10 million to 11 million women worldwide, according to the American Society of Plastic Surgeons and the Plastic Surgeon Foundation. According to the American Society of Plastic Surgeons, over 400,000 women and teenagers have breast implant augmentation procedures each year, with 75% of them for enhancement of healthy breasts and 25% for reconstruction after mastectomy.
Women have suspected that their breast implants have made them quite sick in recent years. Symptoms of autoimmune disorders, such as weariness, muscle and joint aches, fevers, dry eyes and mouth, and occasionally poor memory or concentration, continue to be reported by breast implant recipients.
Unfortunately, most women who want their breast implants removed for medical reasons will be denied coverage by their health insurance. Breast “explant” surgery is not covered by health plans because it is “not medically required” or is restricted by plan restrictions. Dealing with your insurance carrier to get therapy covered can be frustrating and time-consuming. When dealing with insurance providers, knowledge is power. Here are some pointers to help you get the most out of your insurance for breast explant surgery.
Can you claim breast implant removal on Medicare?
- End-stage renal disease patients (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
Cosmetic surgery is generally not covered by Medicare unless it is required due to an accident or to improve the function of a defective body component. Breast prostheses for breast reconstruction are covered by Medicare for people who have a mastectomy due to breast cancer.
In addition, Medicare normally covers the removal of breast implants (saline or silicone) for any of the following conditions:
Additional information regarding Medicare coverage and benefits can be found at https://www.medicare.gov/what-medicare-covers.
We’ve heard from so many women who are having problems receiving insurance coverage for these explants that we thought it could be helpful to compile a list of ideas, facts, and resources that could help with at least one aspect of their suffering.
Please join Senior Attorneys Cari Schwartz and Elizabeth Green of Kantor & Kantor, LLP for a webinar on October 2, 2019 at 10:00 a.m. PST to learn how to get insurance coverage for your breast implant removal procedure. The registration form can be found HERE.
How do I take my implant out?
It only takes a few minutes to remove Nexplanon, although it takes a little longer than putting it in.
A doctor or nurse will give you a shot to numb a tiny portion of your arm, just like with the insertion. The implant is then removed through a tiny incision. When you get a numbing shot, you normally feel a slight pinch or stinging. After that, making the incision or removing the implant should be painless.
If you choose to keep using Nexplanon, you can have another implant placed while the old one is being removed.
Will Kaiser insurance pay for breast implant removal?
Cosmetic breast operations such as re-augmentation and breast lifts cannot be done or assisted under your Kaiser Permanente Health Plan coverage policy.
How painful is breast explant surgery?
Before you leave the hospital, a nurse or other healthcare provider will give you discharge and self-care instructions. This will provide information on the following topics:
Although the recovery time for breast implant removal varies, it usually takes several weeks.
It’s typical to experience some pain, discomfort, and edema following surgery. It will also be difficult to move your arms and upper body as freely as usual. Within a few weeks, you should have better movement and less pain.
During the recuperation time, it’s critical to rest and follow your surgeon’s recommendations to avoid complications.
What happens if you don’t replace breast implants?
Dr. Steven Yarinsky, a board-certified plastic surgeon, explains that while breast implants might endure a long time, they should not be considered lifetime medical devices. Saline implants may deflate if they burst or leak. Capsular contracture, which is the shrinkage of natural scar tissue produced by your body around any implanted medical device, may also develop. This can cause firm or rigid breasts, as well as a visible or palpable malformation. Because the implants are not meant to last a lifetime, they will most likely need to be replaced after 10 to 15 years. Having stated that, if implants are necessary, “If they’re “up and running” and aren’t causing any issues, there’s no need to replace them. Many of our patients have had their implants for over 20 years and have had no complications.
If hard breasts or capsular contracture develops, the thick scar capsule can be removed with or without the implants being replaced. When saline implants break, the salt water filling is resorbed, resulting in an infection “the appearance of a flat tire Leaving deflated saline implants in place can lead to additional capsular or scar tissue contracture, as well as apparent breast deformities. As a result, saline implants should be replaced within a month or two of deflation. If silicone gel-filled implants (also called as saline implants) are used, “No change in breast shape or size is visible when gummy bears”) break, but the affected breast may feel softer. A breast ultrasound or MRI should be performed every 5 to 7 years after silicone gel implant insertion to rule out a problem “There was a silent rupture.” If a silicone gel implant’s shell breaks, silicone oil can leak out. While there is no scientific evidence that loose silicone gel causes harm to the body, the FDA has developed and approved the implants to be used with an intact shell surrounding the gel fill material. Though there may be no difference in the appearance of the breasts, it is recommended that broken gel implants be replaced or, if requested, removed without replacement, out of an abundance of caution and with patient safety in mind.
When patients consider having their implants removed, whether due to a mechanical issue such implant shell breaking, capsular contracture, or personal preference, the topic of whether they should replace their implants or return to their natural breast size arises frequently.
Breast augmentation with implants extends the overlying breast skin envelope, resulting in an increase in breast skin volume. When breast implants are removed without being replaced, there is often a volume and skin mismatch, resulting in breast droopiness or asymmetry “ptosis” is an abbreviation for “ptosis.” As a result, persons considering breast implant removal without replacement should be aware that their breasts may not resemble the same as they did prior to augmentation. The age of a woman, the size of her implants, and the amount of time she has had them can all produce alterations that may not be visible until the implants are removed. For example, the weight of a bigger implant combined with gravity effects over time can cause the skin and breast ligaments to strain, resulting in sagging tissue.
To address the loose skin breast ptosis that follows from removing implants without replacement, Dr. Yarinsky frequently advises a breast lift to remove excess loose skin and tighten the ligaments. This helps to provide a more young and shapely breast appearance while preventing a droopy appearance “deflated” appearance Women with good breast skin elasticity and smaller implants may discover that their breasts recover to the same size and shape they had before breast augmentation after implant removal.
A personalized consultation with a board-certified plastic surgeon is the best approach to learn how your breasts will look following breast implant removal without replacement. Dr. Yarinsky helps patients by modelling and previewing their expected results using Crisalix 3D and 4D imaging technology.
Will my breasts go back to normal after implant removal?
Your breasts will initially appear deflated after the breast implants have been removed. It may take two to three weeks for the breasts to regain their volume. If you have had a breast lift after the breast implants have been removed, your breasts will not appear ‘caved in.’It is important to note that while your scars will heal and fade over time, they will never completely disappear.
Your breasts will not look the same after your breast implant removal surgery as they did before you had the original breast implant surgery. This is due to the weight of the breast implants stretching the tissue and causing alterations in the rib area.
How much does it cost to have the nexplanon removed?
The cost of a birth control implant, commonly known as Nexplanon, can range from $0 to $1,300. The cost of implant removal varies from $0 to $300. The good news is that most health insurance plans, Medicaid, and certain other government programs cover implants for free (or at a modest cost).
Even while the implant is more expensive up front than other options, it saves you money in the long run because it lasts for 5 years.
If cost is a concern, contact your local Planned Parenthood health center to see if they can assist you in finding birth control that suits your budget.
Planned Parenthood can also assist you in obtaining health insurance, as most insurance plans are required to include birth control at no cost to you under the Affordable Care Act (commonly known as Obamacare). Learn more about birth control and health insurance.