Understand your insurance options and reconstruction rights before making decisions about surgical care. Double board-certified plastic and reconstructive surgeon Dr. Kamal Addagatla provides clear guidance at Addora Plastic Surgery, helping you understand important financial considerations while choosing care based on your individual needs.
How Insurance Works at Addora Plastic Surgery
Dr. Addagatla accepts all insurances and works closely with a billing team to help maximize your chance of having insurance coverage. Please call and speak with a member of our team to learn more about your options.
Breast Reduction Insurance Coverage
Dr. Addagatla performs breast reduction through insurance coverage rather than as a purely cosmetic procedure. Whether your plan will cover surgery depends on its definition of medical necessity and its specific requirements. Breast reduction insurance coverage may be available when you experience:
- Persistent neck, shoulder, or back discomfort related to breast size
- Shoulder grooving from bra straps
- Recurrent irritation or rashes beneath the breasts
- Physical limitations that interfere with exercise or everyday activities
- Symptoms that have continued despite appropriate nonsurgical measures
Your insurer may also require medical records, documentation of previous treatment, or removal of a certain amount of breast tissue. Meeting these medical criteria does not automatically guarantee coverage, so your individual benefits and requirements need to be reviewed.
Breast Reconstruction & Insurance
Breast reconstruction following cancer treatment is another important area where specialized plastic and reconstructive surgical care can play an important role. Dr. Addagatla brings advanced plastic and reconstructive surgical training to breast reconstruction, developing each procedure around your cancer treatment, anatomy, health, and reconstructive goals.
If you are considering breast reconstruction, understanding your insurance coverage and benefits is an important part of planning your care. Coverage for breast reconstruction may vary depending on your insurance plan, policy details, and the procedures involved. Our team can help you understand the insurance process and provide guidance on what to expect as you plan your reconstruction.
Know Your Breast
Reconstruction Rights
Federal law provides important protections related to breast reconstruction following a mastectomy. Under the Women’s Health and Cancer Rights Act (WHCRA), group health plans and health insurers that provide mastectomy benefits generally must also provide coverage for certain reconstructive care. This includes reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to create symmetry, prostheses, and treatment of physical complications of the mastectomy.
These protections do not mean every surgeon or service will automatically be covered at the same benefit level. Your network status, insurance plan terms, deductibles, and cost-sharing requirements still matter. Dr. Addagatla and the Addora Plastic Surgery team can help you approach these conversations with clearer information while you evaluate your surgical options.
Additional Information
Out-of-Network and Hospital Affiliation Statement
Dr. Addagatla is out-of-network with all insurance plans and is currently affiliated with Stamford Hospital, Northwell Phelps Hospital, and Northern Westchester Hospital. He works closely with a billing team to help maximize your chance of having insurance coverage. Please call and speak with a member of our team to learn more about your options.
Good Faith Estimate Notice
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.
Why Choose Dr. Kamal Addagatla?
Dr. Kamal Addagatla is a double board-certified plastic and reconstructive surgeon who believes you should have the ability to choose your plastic surgeon based on expertise, trust, and the quality of care you receive, not simply whether a name appears on an insurance network list. He takes the time to understand your circumstances, explain your surgical options, and help you make informed decisions about care that can have a meaningful impact on your quality of life.
That personal relationship continues well beyond your first appointment. You work directly with Dr. Addagatla throughout your surgical experience, with thoughtful planning and attentive follow-up centered on your needs. Located in Westchester and serving patients throughout Westchester and surrounding counties, Addora Plastic Surgery offers advanced reconstructive care with the accessibility of a personal private practice. Schedule a consultation in Westchester to meet Dr. Addagatla and discuss your next steps.
