Dr. Robert Whitfield says breast explant surgery is rarely covered by insurance because breast implant illness has no ICD-10 code. His practice switched to cash-based in 2020. Patients can try financing options, medical deductions, or start with non-surgical testing and supplements while saving.
Hey, it's Dr. Robert Whitfield. Welcome to my breast implant illness podcast. Today we're going to discuss the question, is breast explant surgery covered by insurance? And we get asked this question routinely. And currently, breast implant illness does not have an ICD10 diet code, which is international classification of disease code. So from coding it's hard to get this covered because it's not recognized. Typically what we use for the ICD10 code for this is breast pain because that's indicative of this issue. Many of my patients, if not all of them, have experienced breast pain at one time or another. And for us, the explant surgery is indicated when patients are suffering from breast implant illness or capture contracture or pain associated with the device, whether it's nerve pain or breast pain in general. Certainly there are costs in this setting of the facility where you can do procedure, the anesthesia for the procedure and the cost of the surgeon's fees. And for an insurance company to cover this, you have to show medical necessity. I haven't had this covered routinely. So we used to provide basic letters of medical necessity and that became problematic. Insurers would come back to us and really wonder, you know, what are you doing this for? Why are you doing this? It became complicated and in 2019, in the fourth quarter we wound down my reconstructive practice and went basically in 2020, right before COVID you know, to a purely cash based practice. And I had people who had self administer plans be able to get reimbursement and those were rare because most plans are not self administered. They're through large, you know, companies. So that takes us to how is someone going to manage to prepare for and get this done for themselves when it's an out of pocket procedure? And, and obviously there's utilizing financing which is not uncommon. We use patient fhir routinely. We use alli routinely for financing. These are companies that work with our patients to provide very good options for financing. You can work with your tax strategist and advisors to see if any of this can be written off of your taxes as medical expenses as well. Now, obviously it's challenging to get things funded all the time in these more complicated financial times. So getting support and counseling from your financial advisor and or other patient groups who advocate for explants and helping kind of navigate that. Certainly if someone's not capable of the costs associated with explant surgery. There are ways to work in our program, such as HARP to get started, whether it's on the appropriate supplements or the testing that would help elucidate other factors contributing to inflammation, and work in that program, while simultaneously preparing for the financial investment of the cost of the the procedure itself. But the most important thing is to actually get started on that journey and learn as much as you can about, say, for instance, in in our situation, you know, we guide patients to understand their own systemic inflammation, and it's not carefully considered enough, probably, in the allopathic community. How best to enlighten, you know, our patients about their own inflammation using testing, especially functional medicine testing and toxicity testing and hormone testing and genetic testing and food sensitivity testing versus just serum blood tests that identify liver and kidney function and blood counts and things of that nature. So there are ways to get started that aren't all about having surgery in the beginning. As you can figure out your journey, how that looks to you.
