Breast Augmentation Coverage?

[psvzum 81]

Have any of you had insurance cover breast augmentation after WLS? My surgeon tells me it may if you're getting rash/fungus underneath where the "flaps" hang.

I never even considered having this done but if insurance covers it, maybe. I'm at the "wondering" stage and not in any rush to pursue it. I'll check my insurance if I get serious.

Just wondering about your experiences.

[DaisyAmy 561]

I'm in the wondering stage, too. Following!

[AvaFern 3,516]

Generally insurance won't cover an augmentation, but maybe if your rashes are bad enough they may cover a lift. Then you can pay the difference for the augmentation.

[WLSResources/ClothingExch 3,443]

I can't speak definitively about your insurer or any other, but I have no doubt on Earth that, were you to approach your medical insurer about "augmentation," you'd be slapped down hard and perhaps get them suspicious were you to with the vocabulary they speak. Augmentation will be seen as cosmetic and nothing but cosmetic. What is wanted is more along the line of reconstructive (and I'm not positive that that's the word to present to them; a reconstructive surgeon knows the lingo) surgery to correct deflated balloons flapping against one's abdomen, causing, perhaps among other things, a climate conducive to candidiasis intertrigo, the infection you're speaking of.

Some plans will cover such surgery, others not. You want documentation as backup: Date-stamped photos of the affected area (if you don't get the infection under the belly overhang, good for you); dermatologist visits each time you have recurrence; prescriptions for nystatin-triamcinolone cream.

[Djmohr 6,965]

I have Cigna and so far the only thing that would be covered is if I had breast cancer then reconstruction is covered.

Even in cases where people have gotten some procedures covered it is usually the pannilectomy (not sure that I spelled that correctly) and you really have to have a lot of proof that your panni is causing rashes and infections.

So far, I have not had anything covered. My Brachioplasty cost 5950.00 and my Abdominalplasty and breast lift with augmentation will cost 17K. All of it comes out of my pocket. The scariest part is if I were to get an infection from these procedures, that too would be out of my pocket because it was caused by an elective plastic surgery.

This is my personal opinion but obesity is a metabolic disease and should be considered that way when dealing with reconstruction. This disease leaves us with deformities that should be covered.

Unfortunately that is not the case right now, maybe some day.

[BethinPA 305]

My lift was covered- I didn't get augmentation. My GYN wrote a corroborating letter that helped a lot towards getting it covered. I work for a health system and so get less coverage when I get care outside of my employer network so I ended up paying about 50% of the bill, but it was still less than 100%!

I know that if I change my mind I can go back and get the augmentation as a brief outpatient and so less expensive procedure. Right now I'm happy with just the lift, though.

[jess9395 5,448]

Depends on your insurance I suppose but mine won't cover anything with an augmentation/implant; they will cover reductions and lifts if they fall under very strict parameters.