Removal of Breast Implants

Pursuant to a congressional request, GAO reviewed government and private insurers' payment practices related to the removal of breast implants, focusing on: (1) the number of surgical procedures that involved the removal of breast implants and other complications of breast implants; and (2) physician charges and Medicaid and Medicare payments for such procedures. GAO noted that: (1) most government and private insurers pay for the removal of silicone gel breast implants; (2) all insurers require that the patient's physician determine that the procedure is medically necessary; (3) some government and private insurers deny coverage if implants are being removed solely because of emotional or psychological stress; (4) Medicare, Medicaid, the Department of Defense, and most private insurers pay for breast implant removal when the original implant was done for cosmetic reasons; and (5) government officials were not aware of any beneficiaries denied coverage for the removal of hazardous breast implants.