Are Breast Lifts Covered by Insurance?

Breast lifts and other breast enhancements, such as reductions, are surgeries. they involve medical procedures that must be performed by a licensed physician in a safe and sterile environment. these procedures are not always medically necessary, and that means they may or may not be covered by insurance. Whether or not a breast lift is covered by insurance depends on a number of factors.

The decision to undergo breast augmentation surgery should be made after having all the data. Understanding exactly what the procedure entails, how you prepare for and recover from it, and what financial responsibility you might have are important things to know before proceeding with a breast lift.

Reading: How to get insurance to pay for breast lift

what is a breast lift?

A breast lift is any surgical procedure intended to change the shape of your breasts. They are typically intended to firm and reshape breast tissue and remove sagging skin, leaving your breasts looking firmer and more youthful in shape.

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The breast lift itself, which is called a mastopexy, does not significantly change the size of your breasts. those are separate procedures called augmentation (increase in size) or reduction (decrease in size). however, any of these procedures can be combined with a breast lift to modify the size and shape of the breasts at the same time.

Breast Lift: Procedure Overview

Prior to your procedure, you would have met with a plastic surgeon and discussed your goals and wishes for the procedure. Your doctor will review your medical history and body type and recommend what might be the best options, along with associated risks, so you can make an informed decision. For most healthy patients, breast lifts carry fewer risks than many other surgeries, but any medical procedure carries some risk. however, for patients who follow the provider’s instructions, post-surgery complications are quite rare.

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Most breast lifts can be performed in an outpatient surgical setting, which means you won’t spend a lot of time in the hospital. you will likely be able to go home the same day in many cases.

Total recovery time after a breast lift can be up to six weeks. the first few days to a week are the worst for symptoms such as swelling and pain. you may need to rest, use ice, and prescription or over-the-counter medications to relieve pain. You will also need to care for your incisions according to your provider’s instructions. after the first week, patients usually return to light activity and just need to be careful not to do heavy lifting or excessive activity for a month.

breast lift and insurance

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Breast lifts are not covered by all insurance companies, and even some companies that do cover them do not cover them in all situations. In most cases, the medical necessity of the procedure is what comes into play. If the insurance company deems the procedure medically necessary, they may cover it. this is especially the case for those who need breast reduction surgeries because their breast size is causing other health problems. Sometimes, a breast lift is also needed at the same time to ensure the success of the breast reduction surgery, and in such a case, the insurance company might cover both.

Whether or not you or your doctor believe the procedure is medically necessary, it’s not always enough to convince an insurance company. To determine if your breast lift is covered by insurance, it’s worth taking a few extra steps to see if you can get prior authorization for breast surgery.

  1. Check your insurance benefit documentation to see if it specifically mentions these types of procedures or breast lifts or reductions. know that these policies can be riddled with legal jargon, which can be confusing, so it’s always worth calling the insurance company for clarification.
  2. Ask your doctor to write a letter of medical necessity if there is a chance the insurance company will cover your breast lift. provider offices will usually know what is required in such a letter and may even have worked with the insurance company on other cases. work with your provider to facilitate this process if necessary.
  3. Talk to a caseworker or preauthorization representative from your insurance company to find out what documentation is needed for preauthorization. this is a formal acknowledgment (often in writing) from your insurance company that it authorizes the performance of the services and will cover the service as long as all prior authorization requirements are met.
  4. talk to your provider to make sure the office knows exactly what documentation is required to fulfill the claim and that they are prepared to bill the claim properly.
  5. double check that the surgeon is in your plan’s network. going out of network may mean a loss of coverage for the procedure or a drastic increase in the amount you must pay.
  6. Make sure you know how much your copay and deductible are. Even if the procedure is covered, you may end up owing a portion of the bill.
  7. Whether your breast lift is covered by insurance or not, ask your provider’s office about financial arrangements. you may be able to set up a payment plan, and if insurance coverage isn’t an option, ask if there are discounts for paying in full at the time of service.

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