Our plastic surgery patients from Walnut Creek and surrounding areas sometimes choose to correct medical conditions that may be covered by medical insurance. This page aims to help clarify which procedures might be covered by your insurance company and for what reasons. Remember, this is a general reference. You will need to discuss the unique circumstances of your condition with Dr. Mariotti and your insurance company.
Many women seek breast reduction for aesthetic preference. Often, this procedure is considered cosmetic. However, reducing the breast tissue may be the solution to correcting a difference in size, whether congenital or due to loss by disease or injury. Reduction of very large breasts that are causing back, neck or shoulder pain or causing shortness of breath or difficulty in maintaining proper posture can be sufficient reason for coverage. Although Dr. Mariotti is not contracted with most insurance companies, our office can assist you in submitting the claim to your insurance company.
In the case of the congenital absence of a breast or breasts, breast reconstruction is considered necessary. Other justifications for reconstruction include breast cancer, severe fibrocystic disease of the breasts, prophylactic removal of one or both breasts due to strong family history of breast cancer, or loss due to burn or other traumatic injuries.
Explant of Breast Implants
The removal of your breast implants might be covered by your insurance if they are causing you pain. Rarely, if ever, do insurance companies pay for implant replacement or exchange, even if they cover the explantation.
We recommend that you discuss the details of your condition and the potential for insurance coverage with your plastic surgeon. Pre-approval by your insurance company will help clarify your share of the payment. You are welcome to call us to inquire which plans Dr. Mariotti participates in. For those plans under which Dr. Mariotti is not a participating provider, we can sometimes work out a case-specific agreement with your insurance company.
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