Is Breast Reconstruction Surgery Covered by Insurance?

A common question among breast cancer patients is whether their medical insurance plan will cover the costs of breast reconstruction cosmetic surgery. While the answer is ‘yes’ in many cases, patients should discuss the insurance aspects with their surgeon as well as the insurance provider.

Terrific, pragmatic, and board certified female plastic surgeon Dr. Farah Naz Khan provides breast reconstruction to patients in Dallas, Texas and other towns and suburbs in this region of the sterling state of Texas.

Key Facts about Breast Reconstruction Insurance

Although insurance coverage will vary from case to case, some aspects in breast reconstruction cosmetic surgery insurance are fairly standard. According to the Women’s Health and Cancer Rights Act (WHCRA) mandate, insurance policies must cover breast reconstruction surgery if the patient has had a mastectomy.  

If breast reconstruction is performed following a preventive mastectomy, the patient will still be covered in most cases, provided she is deemed a high risk candidate for breast cancer. As per the Women’s Health and Cancer Rights Act of 1998, every group health plan that pays for mastectomy must also pay for reconstructive surgery and prostheses.

Furthermore, Medicare too covers breast reconstruction, but Medicaid coverage can differ between states.

Check Insurance Aspects in Advance

Even when a patient is covered by insurance for breast reconstruction, it is still possible to run into problems in certain situations.

For instance, if the patient has selected a newer reconstructive technique, is undergoing the surgery to create a more balanced appearance, or requires revision of a previous reconstruction, coverage issues could arise. Another concern could be if the patient wants to select a plastic surgeon who is not within her health insurance plan’s network.

The patient should check with her insurance provider upfront and find out precisely what is covered so that she can make her choices accordingly. The surgeon’s office may also be able to offer guidance about insurance claims. Patients could also check with the health insurance agency and commissioner in their state to know the rules governing coverage for breast reconstruction.

Questions to Ask

The following questions may be used as a guide during the patient’s discussions with the insurer and the surgeon’s office pertaining to breast reconstruction insurance:

• Does my insurance plan cover mastectomy (which will automatically cover reconstruction)?
• How can I obtain pre-authorization for my breast reconstruction surgery?
• Does my plan limit my choices to in-network surgeons and services?
• If I choose a surgeon who is not within my network, what costs would still be covered?
• What will be my out of pocket costs if I choose a surgeon who is not within my network?
• Does my plan cover hospital stay, and if yes, for how many days?
• Does my plan cover other healthcare providers involved in my procedure?
• Will all bills be paid directly to providers?

The patient should be aware that she will still have the responsibility to pay for deductibles and co-pays, and should have a clear idea of how much she will be required to pay out of pocket. Astute, proven, and board certified female plastic surgeon Dr. Farah Naz Khan receives patients from Dallas, Texas and other neighborhoods and communities in this section of the nation for breast reconstruction surgery.

To schedule a consultation with Board Certified Dallas Plastic Surgeon, Dr. Farah Khan please call 469-437-5426 or click here to contact us.

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Oversized breasts are not only an aesthetic concern for many women, but they may also lead to physical discomfort and pain. They will typically cause a hindrance in certain types of activities and movements. Breast reduction cosmetic surgery is an effective and safe procedure to address this condition.

When the procedure is deemed as a medical necessity, health insurance may cover the costs of breast reduction surgery. Board certified female plastic surgeon Dr. Farah Naz Khan of Khan Plastic Surgery provides breast reduction patients in Dallas, Texas and surrounding locations in this spectacular region of the country.

Possibility of Coverage

Excessively large breasts or symptomatic macromastia is a recognized medical condition that requires therapeutic management, and in some cases, breast reduction surgery. Pain in the shoulders, back or neck, rashes in the breast crease, and other symptoms can compromise the patient’s quality of life.

Therefore, breast reduction surgery may sometimes be as necessary as, say, a cervical spine or shoulder surgery to alleviate the various health problems that arise from oversized breasts.

But if the patient is considering breast reduction surgery only for cosmetic reasons while not experiencing any major physical discomfort, insurance will not cover the procedure. In such cases, the insurance provider will treat this as an elective cosmetic surgery.

Insurance Coverage Requirements

When a patient is considering a breast reduction procedure, she should carefully review her medical insurance policy. If the policy does not include breast reduction surgery as a covered surgery, then the patient will not receive coverage in any circumstances. But reduction mammaplasty is not excluded from the list of covered procedures in several cases.

In such instances, the patient will need a letter from the plastic surgeon explaining the patient’s health symptoms, physical findings, estimate of the breast weight that will be reduced, and requesting insurance coverage. The insurer will not be under an obligation to pay if the procedure is not authorized in advance.

Discussion with the Insurance Provider

Top insurance providers are usually aware of the current standards to address macromastia, and they may approve of the insurance coverage as per the documentation proving medical requirement as well as other reasonable conditions. Nevertheless, some insurers still do not pay attention to the past two decades of medical research findings that show the advantages of breast reduction surgery in correcting macromastia.

If the insurance firm does not approve coverage stating that the breast reduction procedure is an elective surgery, the surgeon may inform the insurer about the patient’s condition of macromastia. They should explain the distinction between breast reduction and cosmetic surgery procedures such as breast lift and breast implants. The insurance provider should be given the necessary medical evidence related to the patient’s constant pain and discomfort.

The insurance provider may be willing to provide coverage once they understand that not undergoing the treatment of macromastia could lead to further health complications for the patient. In the long-term, this could save costs for the insurer.

Process of Appeal

The patient can legally appeal in case the insurance provider denies coverage. Various levels of appeal are available to the patient, and she should explore these avenues.

In support of the appeal, the patient can submit letters from the family doctor, breast surgeon, massage therapist, physiotherapist, and chiropractor. Board certified female plastic surgeon Dr. Farah Naz Khan receives patients from Dallas, Texas and other cities and towns in The Lone Star State for breast reduction.

To schedule a consultation with Board Certified Dallas Plastic Surgeon, Dr. Farah Khan please call 469-437-5426 or click here to contact us.

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A patient may require breast implant revision surgery if they are not happy with the outcomes of the primary breast implant cosmetic surgery procedure, or in case the implant develops a complication. During the pre-op consultation, the surgeon will highlight various aspects of a breast implant revision surgery, including its approximate costs.

Khan Plastic Surgery, led by the accomplished board certified female plastic surgeon Dr. Farah Naz Khan, provides breast implant revision surgery to patients in the sparkling and spectacular city of Dallas, Texas and surrounding communities.

Variations in the Sticker Price

The dollar cost of breast implant revision can differ in each case as the length and complexity of the surgery may vary for each patient. Revisions are typically more complex that the primary breast augmentation cosmetic surgery. Therefore, the cost of revision surgery may be more than that of the primary procedure. The surgeon might perform a revision surgery for free if there was an error on their part. This depends on their practice policy on revision procedures.

The patient’s choice of implant replacement or removal will also impact the costs of the revision surgery. The removal of implants typically involves a breast lift as an additional procedure, which will add to the costs of the procedure. If the patient wants implant replacement, the procedure will be relatively simpler, but the new implants will have an additional dollar amount.

The cost of implants in a breast implant revision surgery may be covered under warranty offered by the manufacturer. But if the procedure involves replacing undamaged implants and selecting new ones as a matter of personal preference, the manufacture’s implant warranty may be inapplicable.

Other Financial Elements

The sticker price of breast augmentation revision surgery can differ between practices depending on the location of the practice. Busy urban centers, popular tourist destinations, and coastal cities will usually have higher real estate costs and other overheads. The median cost of most types of goods and services, including aesthetic procedures, will typically be higher in these locations.

The breast implant revision surgery will include the anesthesiologist’s or anesthetic nurse’s fee if the procedure is performed under general anesthesia. The fee will depend on the credentials and experience of the professionals. The patient may undergo surgery at an accredited surgical center, hospital, or private surgical suite. The costs and advantages will vary in each case.

Patients should also account for pre and post-op costs such as specialized mammograms, medical tests, prescription medications, post-surgical consultations, and surgical bra. These small expenses can cumulatively add up to a significant amount and should be a part of the original dollar figure estimate.

Insurance and Financing

Insurance providers will rarely cover the expenses for a breast augmentation revision surgery as it is an elective procedure. As an exception, when implants are used to restore the breast appearance of a patient who has undergone mastectomy, insurance coverage will be available.

All other patients can explore financing options such as bank loans, medical care financing companies, private loans, or credit cards. Considerate board certified female plastic surgeon Dr. Farah Naz Khan receives patients from Dallas, Texas and nearby areas across the horizon.

To schedule a consultation with Board Certified Dallas Plastic Surgeon, Dr. Farah Khan please call 469-437-5426 or click here to contact us.

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A patient may require breast implant revision at some stage after the initial breast augmentation cosmetic surgery procedure. In a majority of cases, breast revision entails replacing old or damaged implants with new ones. However, in some cases, implant removal may be necessary.

Such revision procedures may sometimes be combined with a breast lift surgery to restore the breasts to their original shape. Khan Plastic Surgery, led by board certified female plastic surgeon Dr. Farah Naz Khan, provides breast implant revision surgery to patients in Dallas, Texas and surrounding locations.

Need for Breast Revision

Patients may consider breast revision surgery after the main breast augmentation procedure for various reasons including:

Need to Change Size

A woman may want to change the size of her breasts to make them smaller or bigger. She may want an enhancement in the proportion and shape of the current breasts. The desire to change the size of the breasts is one of the common reasons behind breast implant revision procedures in the US.

Problems in the Implant

Capsular contracture may happen around the implants. This can lead to the implants becoming very tight, getting damaged, or losing their original shape. Implants may need replacement if they rupture at some stage. At times, the implants might become rippled, and this shows up on the breast surface.

Implant Pocket Issues

An issue with the implant pocket can cause the implants to appear far apart from each other, or they might move toward the armpit when the patient lies down. This may warrant revision cosmetic surgery to correct the implant pocket or replace the old implants with new, more proportionate ones.

Establishing the New Implant Size

Patients considering larger sized implants can preview the size and shape of these new implants in a t-shirt or sports bra. Placing a sizer filled with air over the current breast can help achieve this look to enable the patient to better understand the outcome of the surgery.

Women considering smaller implants will also have various alternatives available. If the patient presently has saline implants, the aesthetic surgeon may initially perform a pre-op deflation of such implants. This will enable the patient to “try on” the new implant as well as choose the most suitable size before the breast revision surgery.

Correcting Implant Hardness

Some patients may want to retain the implants after the implant’s hardness is corrected. The surgeon may address this situation by removing the scar tissue layer (which is known as capsulectomy). This procedure involves removing the abnormal scar tissue or breast capsule while not disrupting the healthy breast tissue.

After the hardened scar tissue is removed, the implant will not contract into a rigid and unnatural shape. The breast will become soft and more comfortable again.

Removing implants may involve a slightly extended downtime as the surgeon might need to combine it with a breast lift procedure. A majority of women can return to their routine activities in a week or two after the revision procedure. Board certified female plastic surgeon Dr. Farah Naz Khan receives patients from Dallas, Texas and nearby areas in this tremendous part of the nation.

To schedule a consultation with Board Certified Dallas Plastic Surgeon, Dr. Farah Khan please call 469-437-5426 or click here to contact us.

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