Robert Whitfield MDAmerica's Breast Implant Illness Expert™

Which Types of Health Insurance Will Pay for Explant Surgery?

19 Jun 2023 · 1 min

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A short excerpt from a YouTube video by Robert Whitfield MD discussing difficulties obtaining insurance coverage for explant surgery. He explains insurers require demonstration of medical necessity, that letters of medical necessity often failed, and that in late 2019 he wound down reconstructive practice and by 2020 converted to a cash-based practice. He notes rare cases where patients with self-administered insurance plans obtained reimbursement, but most plans are employer/large-group administered and did not reimburse.

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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 basically 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 2000, 19, 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 administered plans be able to get reimbursement. And those were rare because most, most plans are not self administered. They're through large, you know, companies.