A breast lift, also known as mastopexy, is a cosmetic surgical procedure that raises and reshapes sagging breasts. Over time, factors like pregnancy, weight changes, gravity, and aging can cause breasts to lose volume and firmness, resulting in drooping, sagging, and stretched skin.
While not medically necessary, a breast lift can dramatically improve the appearance and position of the breasts. However, as an elective cosmetic procedure, health insurance typically does not cover the costs. Understanding what breast lift procedures your insurance may or may not pay for can help you make informed financial decisions if you’re considering this surgery.
Overview of Breast Lift Surgery
During a breast lift, excess breast skin is surgically removed and breast tissue is repositioned to return the breasts to a more youthful, perky profile. The nipple and areola are also shifted up to a more natural position.
There are a few techniques your plastic surgeon may use:
- Crescent lift: Removes a crescent-shaped portion of tissue above the areola. Minimal scarring.
- Circumareolar lift: Reshapes breast tissue and repositions the areola and nipple without visible scarring.
- Anchor lift: The most common technique is using an anchor-shaped incision pattern. Allows significant reshaping.
The surgery is performed under general anesthesia as an outpatient procedure. After 1-2 hours, you can return home to recover. Downtime is about 2 weeks.
While a breast lift recontours the breast, it does not significantly alter its size. Many patients combine a lift with breast implants for fuller, lifted breasts.
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Is Breast Lift Surgery Covered by Insurance?
For the majority of patients, breast lift surgery is considered an elective cosmetic procedure by insurance companies. This means they will not cover any portion of the costs.
However, in certain medical circumstances, breast lifts may be deemed medically necessary, and insurance will provide payment. Potential situations where coverage may apply include:
- Post-Mastectomy Reconstruction: After a mastectomy for breast cancer treatment, insurance will often cover a breast lift procedure on the affected breast to achieve symmetry with the untouched breast. This ensures the best reconstructive result.
- Macromastia Relief: Women with extremely oversized, heavy breasts that cause significant pain and physical symptoms may receive insurance coverage for a reduction and lift. Documentation from a doctor confirming medical necessity is required.
- Congenital Defects: Breast lifts or reductions needed to correct highly asymmetric breasts due to birth defects or congenital conditions may also receive insurance payments.
Outside of distinct medical needs like these examples, cosmetic breast lifts remain non-covered procedures, requiring out-of-pocket payment by the patient.
Steps for Getting Insurance Approval for a Medically Necessary Breast Lift
If your breast lift appears to meet the criteria for medical necessity based on a health condition, getting approval from your health insurance provider requires taking the right steps. Here is the general process:
1. See Your Primary Doctor
Your first appointment should be with your primary care physician or specialist overseeing your breast condition (such as an oncologist). Describe your breast-related symptoms and difficulties to have them fully documented in your medical records.
Your doctor can then examine you and confirm if a breast lift procedure could alleviate medical problems related to your breasts. Ask them to formally indicate the medical necessity in a letter of support.
2. Consult With a Plastic Surgeon
Make an appointment with a board-certified plastic surgeon who has significant experience performing breast lifts. Discuss whether a lift is appropriate for your condition and goals.
Have the surgeon evaluate and validate the medical necessity, if applicable. Request a letter from them outlining how a lift will treat your medically diagnosed breast condition.
3. Contact Your Insurance Provider
Call your insurance company and explain that you and your doctors believe you may qualify for breast lift coverage due to a medical problem. Ask what documentation they require for pre-authorization.
This typically involves submitting the letters from your doctors along with medical records corroborating your condition and symptoms. You or your doctors will then need to formally request pre-approval for insurance coverage of the procedure.
4. Obtain Pre-Authorization
After submitting all the required paperwork, your insurer will review the documentation and either approve or deny coverage for a medically warranted breast lift.
If authorized, make sure to get the pre-approval in writing, indicating they will cover your upcoming procedure based on medical necessity. You can then have your surgery scheduled, knowing insurance will pay.
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What Costs May Be Covered by Insurance for a Breast Lift?
With pre-authorization for a medically necessary breast lift, insurance will usually cover the following costs to some extent:
- Surgeon’s fees
- Operating room charges
- Anesthesia fees
- Overnight hospital stay (if required)
- Post-op compression garments
- Prescription medications
However, your deductible and coinsurance will apply. And limitations often exist, such as:
- Possible denial of coverage for out-of-network providers
- Higher coinsurance percentages (e.g. 30% instead of 20%)
- Caps on surgeon fees or hospital charges that it will pay
So insurance will only cover a portion of your total costs. Expect to pay any applicable deductibles first, plus coinsurance amounts above what your insurer reimburses.
What Costs Will You Pay Out-of-Pocket?
For cosmetic breast lifts not covered by insurance or those only partially paid for, you should be prepared to cover the remaining costs. Here are some common out-of-pocket expenses to budget for with breast lift surgery:
- Surgeon’s Fee – The surgical fee depends on the scope of the lift but averages $4,000 – $7,000 nationwide.
- Anesthesia – Anesthesia costs typically add another $1,000 – $1,500.
- Facilities – Operating room and other facility fees average $2,000 – $4,000.
- Prescriptions – Antibiotics and pain medication average $100 – $200.
- Compression Garment – Post-surgical compression garments to reduce swelling run $50 – $150.
- Lab Tests – Lab testing prior to surgery may cost $300 – $500.
Factor in costs like time away from work for recovery and any postoperative help you may need at home in the first few days after surgery as well.
Insurance Coverage Considerations When Combining a Lift with Breast Implants
Some patients opt to pair a cosmetic breast lift with breast augmentation for added volume and enhanced breast contouring. But does insurance cover implants with a medically needed lift?
In most cases, the implants will not be covered, even if the lift is deemed medically necessary. The exception would be breast reconstruction following a mastectomy. For cancer patients, implants are considered an integral part of a complete breast reconstruction, and insurance will usually pay for them.
For cosmetic augmentation combined with a medically warranted lift, the implant costs remain entirely out-of-pocket. Only the lift portion will receive insurance payments after pre-approval.
Weighing the Pros and Cons of Breast Lift Surgery
Pros of Getting a Breast Lift:
- Improves breast shape, firmness, and contour
- Can reduce neck, back, and shoulder pain caused by heavy breasts
- Boosts confidence and self-esteem
- Loose-fitting clothes fit better
- May eliminate need for specialized bras
- Breasts appear more youthful overall
Cons of Breast Lift Surgery:
- Significant out-of-pocket costs if not covered by insurance
- Scarring around the areola and possibly vertically down the lower breast
- Risk of changes to nipple sensation or ability to breastfeed after surgery
- Possibility of needing revision surgery
Finding the Right Plastic Surgeon for Your Breast Lift
Choosing a skilled, experienced board-certified plastic surgeon is perhaps the most important decision when planning any cosmetic breast surgery. Here are tips for selecting the right surgeon:
- Check their credentials. Confirm they are certified by the American Board of Plastic Surgery (ABPS).
- Look for extensive, specialized experience performing breast lifts and augmentations. Ask how many they have completed.
- Review before and after photos to evaluate their artistic skill and aesthetic sensibilities.
- Schedule several consultations to meet potential surgeons in person before deciding.
- Choose a surgeon you feel comfortable with. Make sure they listen to your goals and address all your concerns.
- Select a surgeon who operates in an accredited surgical facility for safety assurance.
- Read reviews from former patients, but be wary of doctors who seem to incentivize only positive reviews.
Take the time to carefully choose a surgeon who can artfully deliver the breast lift results you desire in a safe setting.
To Recap: Navigating Insurance Policies and Out-of-Pocket Costs
For the majority of patients, breast lift surgery is classified as a cosmetic procedure that must be paid out-of-pocket. But in cases where excessively heavy or large breasts or reconstructive needs cause physical symptoms or difficulties, insurance coverage may be possible.
Knowing what circumstances could warrant pursuing pre-authorization from your health insurance provider can give you options. If medical necessity for a breast lift can be established, submitting the right documentation could mean insurance covering some of the costs.
However, securing approval tends to be challenging. Electing to move forward with a cosmetic breast lift should only be done if you feel prepared to cover deductibles, copays, and other expenses not reimbursed by insurance. Discussing cost projections with your plastic surgeon can give you the information needed to make an informed choice.
Breast Lift Insurance Claim FAQs
If my primary insurance denies coverage, can I appeal?
Yes, you can file an appeal letter to dispute your insurance company’s decision denying coverage. Provide additional documentation from your doctors explaining why the breast lift is medically necessary for your health and treatment. But approvals after initial denial are uncommon.
Does my age affect coverage for a breast lift?
Typically not, but for adolescents seeking coverage for excessively large breasts causing health problems, some plans may impose age requirements, like being over 18.
How long does the approval process take?
It can take 4-6 weeks to get an answer on pre-authorization after submitting all requested medical records and letters. Start the process well in advance of when you hope to schedule surgery.
Can I get approved for a lift just for back or neck pain?
This is challenging unless there is clear medical evidence that extremely heavy breasts are the direct cause of documented chronic back, neck, and shoulder pain not relieved by other treatments.
If I need revision surgery later on, is it covered?
Not usually. Insurance that paid for the initial breast lift surgery will view subsequent revision or touch-up procedures as cosmetic and not medically necessary.
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