In general, each specific insurance company determines what procedures they will or will not cover. The biggest factor insurance companies consider is whether the procedure is reconstructive or cosmetic in nature. The American Medical Association (AMA) defines these as follows:
- Reconstructive surgery refers to procedures performed to correct trauma, developmental defects, infection or disease. Reconstructive procedures focus on improving function or normalizing appearance of the patient.
- Cosmetic surgery refers to procedures that are focused on improving the aesthetic appearance of the face or body to improve a patient’s appearance or self-esteem.
Many insurance companies, however, can interpret the above definitions differently depending on the specific procedure and situation. Due to these variances it is very important to contact your insurance provider and discuss how your procedure will be classified. While plastic surgeons (and their billing representatives) can counsel you on the potential for insurance coverage it’s always best to go to the source.
In general, breast lift surgery is considered cosmetic in nature and is not likely to be covered by medical insurance. For such a procedure to be approved, medical necessity would have to be demonstrated. There are some circumstances where back/neck/shoulder problems can be traced to very enlarged breasts and a case of medical necessity for breast reduction surgery has successfully been made. But if you are just losing the battle with time and gravity, you should not expect a breast lift to be covered by your health insurance.
If you are interested in breast lift surgery in Gainesville, contact Dr. David W. Allison at 703-754-8228 or mdallison.com to schedule a consultation. Dr. Allison will evaluate your specific areas of concern and let you know if your desired surgery may be deemed medically necessary and possibly covered by your insurance.