Breast lifts and other breast enhancements, such as reductions, are surgeries. They involve medical procedures that must be performed by a licensed practitioner in a safe and sterile environment. These procedures aren’t 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 get any breast augmentation surgery should be made after you have all the facts. Understanding exactly what the procedure entails, how you prepare and recover from it, and what financial responsibility you might have are all important things to know before going forward with a breast lift.
What Is a Breast Lift?
A breast lift is any surgical procedure that is meant to change the shape of your breasts. Generally, they are meant to firm and reorganize breast tissue and remove sagging skin, leaving your breasts looking firmer and younger when it comes to their shape.
The breast lift itself, which is called a mastopexy, doesn’t significantly change the size of your breasts. Those are separate procedures called augmentation (increasing the size) or reduction (decreasing the size). However, either of those procedures can be coupled with a breast lift to alter the size and shape of the breasts at the same time.
Breast Lifts: Overview of Procedure
Prior to your procedure, you would have met with a plastic surgeon and discussed your goals and desire for the procedure. Your doctor will review your medical history and body type, and provide you with a recommendation on what the best options might be, along with any associated risks, so you can make an informed decision. For most healthy patients, breast lifts come with less risk than many other surgeries, but any medical procedure does have some risk. However, for patients who follow provider instructions, post-surgery complications are fairly rare.
Most breast lifts can be performed in an outpatient surgical setting, which means you won’t be spending a lot of time in the hospital. You will likely be able to return home the same day in many cases.
The total recovery time after a breast lift can be up to six weeks. The first few days to a week are the worst with regard to symptoms such as swelling and pain. You may need to rest, use ice and either prescribed or OTC medication to alleviate aches. You will also need to care for any incisions following provider instructions. After the first week, patients usually return to light activity and just have to take care not to do any heavy lifting or overdo activity for a month.
Breast Lifts and Insurance
Breast lifts are not covered by all insurance companies, and even some companies that do cover them don’t in all situations. In most cases, the medical necessity of the procedure is what comes into play. If the insurance company deems the procedure is medically necessary, they may cover it. This is especially the case for those who need breast reduction surgeries because the size of their breasts is causing other health issues. 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 deem the procedure medically necessary isn’t 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 a breast surgery preauthorized.
- Look through your insurance benefits paperwork to see if it mentions these types of procedures or breast reductions or lifts specifically. Know that these policies can be steeped in legalese, which can be confusing, so it’s always worth a call to the insurance company to ask for clarification.
- Ask your doctor to write a letter of medical necessity if there’s a chance the insurance company might 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 in other cases. Work with your provider to facilitate this process if necessary.
- Talk to a caseworker or pre-authorization representative at your insurance company to find out what documentation is needed for preauthorization. This is a formal (often written) recognition from your insurance company that it authorizes services to be performed and will cover the service as long as all the preauthorization requirements are met.
- Talk to your provider to ensure the office knows exactly what documentation is required to make good on the claim and that they are prepared to bill the claim appropriately.
- Double check that the surgeon is within your plan’s network. Going out of network can mean a loss of coverage for the procedure or a drastic increase in how much you may need to pay.
- Make sure you know how much your copay and deductible are. Even if the procedure is covered, you may end up owing some portion of the bill.
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 the total amount at the time of service.
