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Does insurance cover the cost of breast explant?

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Does insurance cover the cost of breast explant? This the subject of today’s Q&A. I hope to answer all of your questions as we go through this series on breast implant illness and breast explant surgery.

This was honestly my husband’s first question because obviously surgery is super expensive, and I’d love all the financial help I can get.

I plan to submit my claim to my insurance company. You can see all of my breast implant illness symptoms here. When I submit my request, I’ll let you know how it goes.

Will my insurance cover my en bloc procedure?

The short answer is probably not. BUT there is hope.

If you check out the Facebook group and search for your specific insurance company, you may find someone who figured out how to get the company to pay.

It doesn’t make much sense that insurance companies will pay for numerous medical tests, doctor visits, hospital visits, and every other claim that arises from our implant illness except solving the problem.

You can try to file your claim (my doctor doesn’t even submit claims), but the chances that you will get approval are rare. If you find someone that has gotten theirs paid for using the same insurance company you use, find out what codes the doctor submitted.

What Does Your Insurance Plan Say About Explant Coverage?

Below I’m sharing links to some of the top health insurance providers in the USA. What you will find is similar wording on each plan. They generally don’t cover it. Even though many (if not all) plans mention rupture or illness related to the implants, you will have a hard time getting the companies to cover the cost of an explant.

It’s important to pay attention to what your plan says because you don’t want to submit a claim coded for an auto-immune disease if your insurance specifically says it will not cover that.

Pretty telling though, isn’t it?!

Tricare
UnitedHealthcare
Blue Cross Blue Sheild (just one example)
Anthem
Cigna
Medicare – By State
Molina

Join the FB group here and search for your insurance carrier. Good luck!

Please let me know what your experiences are with getting insurance to cover your breast explant.

Interested in reading more? Check out these posts

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