For women who have had mastectomies as a result of breast cancer, The Women's Health and Cancer Rights Act (WHCRA) has been able to ensure breast reconstruction will be covered by insurance for most cases.
Under WHCRA, coverage includes costs for breast reconstruction of the breast the mastectomy was done on as well as additional reconstructions done on the other breast to match and be symmetrical with the other.
In most cases this will also include prosthesis or breast implants.
Any complications caused as a result of the mastectomy or implant procedures will be covered as well.
Keep in mind however that the WHCRA regulations do not apply to Medicare and Medicaid.
Another situation in which insurance will likely cover breast enhancement procedures is in breast reductions.
While they are not automatically covered by all insurance companies, as long as they meet medically necessary requirements, they will cover the actual surgery but may or may not cover costs related to complications or follow up surgeries.
Some insurance policies can dictate the amount of breast tissue to be removed and will not cover your surgery if the amount is below or under what they specified.
Many companies require that the surgeon be able to prove they can remove at least 500 grams, or a half pound, from each breast.
Your best bet to getting a breast reduction surgery approved by your insurance company is to find a plastic surgeon that is board certified and well experienced with breast reductions.
You will also need to have your surgeon or general practice doctor write a letter stating that this surgery is necessary as your current breast size hinders your daily life, causing pain or dangerous rashes.
Including photos will increase the likelihood of approval even more.
Keep in mind that some but not all insurance companies will cover the procedures needed to remove a ruptured implant, especially when part of a cosmetic-only augmentation.
It is easier for women who have received medically necessary breast reconstruction to have breast implant removal covered.
Even in these cases they will need to prove that the implant is indeed ruptured with the results of an MRI scan.
MRI scans are usually not covered by insurance, so keep this in mind as silicone gel-filled implants are supposed to be scanned once every two years.
The MRI guided biopsy for breast cancer diagnosis can usually be covered with a written letter from your doctor.
In any case, you can try to get your doctor to help you appeal any insurance denials by phone or letter.
While insurance companies will very rarely cover breast augmentations, the procedures can end up affecting your current health insurance policy.
Some companies have been known to increase premiums, deny future coverage relating to your breast enhancement surgeries and even drop coverage completely.
It is important to find out about all of these factors before consenting for the surgery.
Even if you remember seeing coverages and allowances for breast lifts, reductions or other surgeries when you originally enrolled in your insurance, be sure to double check as these coverages and limits may change from year to year.
Breast lifts in most cases are not covered by insurance as they are generally viewed as purely cosmetic surgeries.
However, if approaching it is filed as a breast reduction instead of a breast lift with a procedure such as a bilateral maxoplexy you may have a better chance of getting it covered.
This type of surgery combines the mastopexy to correct the shape and breast implants to correct volume.
Insurance companies are more likely to cover breast lifts in women who have lost a significant amount of weight and the extra breast tissue causes backaches, headaches, neck aches or even rashes under the breast.
If choosing this route you must be sure your medical history is well documented and you can provide a letter from your doctor supporting this.