Will insurance cover a 2nd reconstruction for fat grafting

Misha1

I am having reconstruction 13 years after breast cancer. I had a lumpectomy, chemo and radiation. I have had two biopsies through the years since then. So my non cancer breast is 2+ cup sizes different and my radiated breast is also indented. So I'm scheduled for a reduction and then a lift on both with no implant. But today at pre op my surgeon asked if I was ok with the size of my radiated breast as she is reducing the other to match size. I said I was little concerned about it being too small as I'm used to being a DDD, but I do want to be smaller, but proportioned to my body. So she said we can always do fat grafting with liposuction later if you aren't happy with the size or symmetry. That wasn't mentioned the first visit, because I told her just reduce , because the previous surgeon didn't give it as an option. So does insurance pay for a second surgery of the fat grafting if I decide this first surgery didn't have the result I was looking for? Surgeon also said fat grafting a radiated breast helps it heal better with less infection than just shaping within it and doing a lift.Thanks to anyone with insight.

Moderators

Misha - Sorry you had to join us, but we're glad to see that you found our amazing Community and decided to post. We can't really help you with your question, but hope you get responses from other members who can help soon. In the mean time, you may find the following article from our main site helpful:

Reconstruction Coverage Under the Women's Health and Cancer Rights Act

Best of luck with surgery! And please, come back to let us know how you're doing!

The Mods

Lula73

yes they should provided the surgeon’s Office Bills it with the proper ICD-10 codes. Not all PS offices know which codes to use when it comes to lipo+ fat grafting for recon purposes though, so be sure to call the PS’s Office ask if it would be out of pocket or covered by insurance. Hope this helps!

Meow13

Yes. My plastic surgeon said it is an on going thing. I might get another fat grafting..

PNWBCHgirl

yes it should be covered if The insurance billing and doctors notes are coded correctly. My last revision was first denied but all the PS had to do was call them and clearly state it was a revision to reconstruction due to breastcancer.

NotBrokenJustBent

Does anyone know if there is a time limit on reconstruction? it has been five years and I never finished. Can insurance say that if you were ok up til now you are good enough going forward. I just wondered if there are time limits from start to finish. I kinda doubt it but it has long been in the back of my mind.

Artista964

i highly doubt there's a time limit. Never heard of one.

Meow13

There is no time limit. A friend of mine had her diep 16 years after mx.

NotBrokenJustBent

Thanks for the input. I am not emotionally ready for another operation yet but thought maybe I should push myself because of the potential that insurance might deny me after a time. Always grateful for your advice.