A breast lift (mastopexy) offers many benefits as it improves the shape and position of aging, sagging breasts. Women often ask if breast lift surgery qualifies for insurance coverage. This blog goes into detail about when breast surgery might be covered by insurance and what you can do if insurance isn’t an option for your procedure.
3 Min Read:
Insurance Coverage and Medical Necessity
Medical necessity is a criterion insurance companies use to determine whether they will cover a procedure. The definition of medical necessity includes treatments and surgeries used to prevent, diagnose, or treat a medical condition. Cosmetic procedures normally do not fit into this category, so surgeries performed for strictly cosmetic reasons do not qualify for coverage. Breast lifts are almost always considered cosmetic when they are performed as a standalone treatment.
Reasons to Undergo Breast Lift Surgery
Women often pursue a breast lift for the following reasons:
- Reduce sagging and loose skin after weight loss
- Restore breast contour after pregnancy and breastfeeding
- Create symmetry between two uneven breasts
- Reposition nipples that point downward
While a breast lift offers numerous benefits and can correct a variety of concerns, the reasons behind the surgery are not considered medically necessary by insurance standards.
Combining a Lift With a Breast Reduction
Women who have large, pendulous breasts that are sagging may opt to combine their breast lift with a breast reduction, also known as reduction mammoplasty. Unlike a lift, breast reduction can sometimes be recommended for medical reasons, including:
- Chronic back, neck, and shoulder pain
- Persistent skin rashes and infections
- Poor posture affecting spinal alignment
- Tingling in the arms or hands
- Difficulty exercising or performing daily activities
- Restricted breathing
If you experience any of these symptoms, you need to provide documentation to your insurance provider for the surgery to be considered medically necessary. Documentation usually includes diagnoses of medical conditions and records of failed conservative treatments, such as physical therapy. Your documentation must also span a prescribed period, usually six months or longer, before insurance will consider coverage for surgery.
If your breast reduction qualifies for insurance coverage, you can undergo your lift and reduction at the same time and use insurance coverage for the reduction portion of the procedure. This can be a cost savings on the lift surgery, since coverage typically includes fees for services such as anesthesia and facility charges.
How Much Is a Breast Lift Without Insurance?
Breast lift cost varies considerably from patient to patient, based on the amount of correction required, the location of your surgery, and the experience of your surgeon. Dr. Stevens will create a surgical plan tailored to your needs at your initial consultation and provide you with an accurate cost estimate at that time.
Dr. Stevens believes cost should not be a barrier to patients seeking improvements to their personal appearance and well-being. He offers a variety of financing options to his patients, including:
- Checks, cash, or money orders
- Credit cards, including Visa, MasterCard, and Amex
- Healthcare lending services like Prosper and CareCredit®
His office also works with patients seeking insurance reimbursement for their procedures to reduce out-of-pocket expenses. However, patients should contact their insurance provider directly to determine whether any coverage is available for their surgery.
Learn More About a Breast Lift in Beverly Hills
With or without insurance coverage, a breast lift is an investment in your appearance and your quality of life. Dr. Leslie Stevens is a board-certified plastic surgeon with 22 years of experience helping patients achieve their aesthetic goals at the Lasky Clinic. If you would like to learn more about your options for a breast lift in Beverly Hills, call our office today at (310) 556-1003 or complete our online contact form to schedule your consultation.