HOW TO GET YOUR INSURANCE COMPANY TO PAY FOR YOUR BREAST IMPLANT REMOVAL
I’ve read some great success stories on women who were able to have their insurance pay for their breast implant removal. Unfortunately, I have read other stories, where women weren’t so successful. Many have said their insurance companies declined their implant removal procedure instantly, even though they took the same steps as others.
If you have Breast Implant Illness, I’m sure you are looking to get your implants removed immediately. Here’s the good news… getting your insurance company to pay for the procedure could be a possibility for you.
I’m sure like many of us you have spent a lot on medical bills just trying to find out why you feel terrible all the time. Or why some days can’t even get out of bed!
Do you have Breast Implants… This will be helpful to know:
No Coding For Breast Implant Illness
As I have mentioned in my last post, (It’s Time To For Breast Implant Illness To Be Recognized), Breast Implant Illness is not recognized as a ‘real’ medical condition. And since BII can’t be proven according to some ‘experts, there is no legislation for medical coding to do an explantation and/or capsule removal.
But there might be a way around those codings for now. But as far as I have seen and with my own experience, this is not an easy process.
The Codes
The national database of codes used among all doctors for billing the insurance companies for the exact procedures is called CPT codes. A CPT code is a five-digit numeric code (with no decimal marks), although some have four numbers and one letter. Each code is uniquely assigned to different actions.
But first, you have to have an ICD-10 Code from your primary doctor. He will use these codes to refer you to a specialist, in this case, a plastic surgeon. These are codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
As you can see, these codes are important to diagnose you so your specialist doctor (a plastic surgeon) will take your explantation seriously.
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What CPT Codes Can You Use If You Have BII?
Depending on your insurance, you want to use CPT code 19371 which involves removal of the capsule and implant. Having the capsule removed is so important because this is where a lot of the implant toxins are stored. Toxins will continue to seep into your body even after your implant is removed if you don’t have a capsulectomy as well.
If possible, you want to see if your insurance will also take CPT code 19318. This is a bilateral coding for a breast reduction or reduction mammoplasty.
Many women want to have this procedure covered, since removing your breast implants could leave you with extra skin and need reshaping of the breasts. This is a long shot… but some women have had success with getting their insurance to cover this as well!
Getting Your Surgeon To Recognize These Codes
The hard part is trying to get your surgeon to recognize that you need your implants removed. And done without talking to the surgeon about Breast Implant Illness. In my situation, the plastic surgeon, I went to, didn’t believe in BII and many others don’t as well.
Why would they believe in a disease where they are an accomplice? They are willingly putting in a product, into women’s bodies, that are making them sick. So it kinda makes sense, right?! Deny, Deny, Deny or turn a blind eye.
Preauthorization
The key is to convince your primary doctor is to use the ICD-10 Codes for illness and PAIN. Mainly ‘pain’ caused by your implants. NO one can tell you or gauge how much pain you are in (or not in ;). You want to show you have chronic breast pain and it is medically necessary to have your implants removed.
As of now, this is where I am at with my journey to removal. I am trying to establish a new primary doctor that is in my insurance plan network. As well as finding the right ICD-10 Codes to help get that doctor to refer me to a plastic surgeon.
The sad thing is, those of us with BII can’t just go in and say I have BII to get our implants removed. IF we want to save $1000s by getting our insurance companies to pay for the procedure, we have to jump through a few hoops to make it happen.
I’ll keep you posted and updated, so hopefully, your path is a lot smoother than mine!
