Valley woman trying to get insurance companies to cover breast implant removal

While it can cost as little as $5,000 for breast implants, getting them removed for a medical reason can cost triple that
Published: May. 31, 2022 at 6:24 AM MST
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PHOENIX (3TV/CBS 5) -- While it can cost as little as $5,000 for breast implants, getting them removed for a medical reason can cost triple that. Arizona’s Family has learned that most women who want their breast implants removed for medical reasons will have their coverage denied.

In 2015, Melody Viscariello underwent a mastectomy and implant surgery after battling breast cancer. She helped who helped pass a new law in Arizona requiring people getting breast implants to be given information about what could go wrong. That law went into effect this year.

After getting the implants, she became the sickest she had ever been. Like most women with breast implant illnesses, she suffered from chronic fatigue, headaches, and joint and muscle pain. Although doctors validated her symptoms, she had to take out a loan to pay for the removal and has dedicated her life to spreading awareness about the disease.

Currently, insurance companies do not have a diagnosis code for breast implant illness and therefore, there is no code that is needed to get them removed. So now, Viscariello continues her fight by focusing on getting insurance to recognize the ICD code, which is required in order to process payments electronically. For example, she says there’s a code for a stubbed toe but no code for breast implant removal.

“It’s so scary, just imagine, and now you don’t’ have the funds to get these debilitating bags out of your chest when you know that that’s what it is now because there’s so much medical information now,” Viscariello said.

Helping patient advocates like Viscariello is Arizona plastic surgeon Dr. Raman Mahabir. He helped pass that law and is working once again with her to bring changes to the insurance process. But why does it get denied? When the computer sees there isn’t a code for this, it’s automatically denied by the insurance companies.

“There’s a code for I stubbed my right toe; there’s literally a code I stubbed my right toe. He puts it in and gets paid because he saw a medically necessary procedure. Right now, that does not exist for breast implant illness,” said Mahabir.

The pair have made some progress. Viscariello has operated a nonprofit called “Just Explant,” raising money for women who can’t afford to pay to get their implants removed.

“Some of these women are getting in touch with me saying, is there any way you can help me, can you help me get these out? That’s what my nonprofit is about helping these women for the cost to get them out,” said Viscariello. “We have good data, good evidence that show the women that are truly sick implants out most often, get better. It’s not up for debate anymore.”