Sample Letters of Medical Necessity for Insurance Coverage of Explantation

If you want to have your breast implants removed for medical reasons, and want your insurance company to pay for it, you will need a letter of medical necessity sent from your doctor to the insurance company.  Most plastic surgeons are not experienced at writing these letters, but we are!  Below are several sample letters of medical necessity describing different medical reasons for needing to have your breast implants removed.

For augmentation patients, most insurance companies will only cover the cost of breast implant removal for capsular contracture, chronic breast pain, or ruptured silicone gel implants. For that reason, our three sample letters focus on those issues. However, if you have other issues such as seromas or autoimmune disease symptoms, please reach out to us and we can help you find a compelling way to explain your symptoms to your insurance company. Unfortunately, we have found including breast implant illness or other autoimmune or connective tissue disease symptoms in your insurance claim makes it more likely that your claim will be denied.  However, we can work with you to maximize your chances of being covered.

If you are using these letters without our guidance, please be aware that these are broad examples that need to be tailored to your specific case. Please make sure to edit all the highlighted portions and to make sure that the letter accurately reflects your symptoms. We would be happy to assist you in strengthening your letter by personalizing it on your behalf.  If you would like our assistance, please take our short survey and we will email you soon! You can also reach us at info@breastimplantinfo.org.

Letter for Ruptured Silicone Gel Implants – Here is our sample letter of medical necessity written for a woman with at least one ruptured silicone gel breast implant. Click here to download this letter as a word document you can edit.

Letter for Capsular Contracture – Here is our sample letter of medical necessity written for a woman with hard or painful breasts caused by capsular contracture (classified as Baker III or IV). Click Here to download this letter as a word document you can edit.

Letter for Breast Pain – Here is our sample letter of medical necessity written for a woman who has chronic breast pain or back pain caused by the weight of her implants, but does not have capsular contracture (her breasts do not feel hard). Click Here to download this letter as a word document that you can edit.