I'm 16, 5 Ft Tall, and Wear a 42 DDD. I Would Like to Have a Breast Reduction but my Insurance Company?

I am 5 ft tall 16 yrs old and wear a 42DDD. I wanted to have a breast reduction but my insurance company stated that i must be 18 to have the procedure done even though i'v been done developing for about 3 years. What insurance companies will pay for someone like me to have a breast reduction?

Doctor Answers (5)

Insurance coverage

+1
Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX


Houston Plastic Surgeon
4.5 out of 5 stars 114 reviews

Breast Reduction at 16 years old

+1

Thank you for your question.

You may want to ask your parents to call your pediatrician and also the plastic surgeon whom you saw so that they can appeal the insurance companies decision not to pay for your breast reduction surgery. Each insurance company differs with what they want / need for approval. Sometimes having letters from chiropractors or other doctors helps as well.

Best of luck.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 682 reviews

Breast reduction at 16

+1

If like you say you are no longer growing, then I do not see why your insurance company will not allow you to undergo the procedure.  You may want to go with another insurance company or pay for it yourself.  Good luck.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

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Insurance Coverage for Breast Reduction at Age 16

+1

You are doing the right thing by seeking out an insurance company but I don;t think anyone on this site will be able to give you a good answer since insurance policies and coverage vary from area to area and even within the same insurance company. Most large insurance companies have many smaller plans with some excluding breast reduction altogether. 

You will need to start by checking out your local insurance plans.

Karol A. Gutowski, MD, FACS
Ohio Plastic Surgeon
5.0 out of 5 stars 17 reviews

Never too young for a breast reduction

+1

In my opinion, your insurance company is completely unjustified in their position that you are too young for a breast reduction.  You have a condition that they cover as an adult as a medical necessity, there is no justification for it to not be covered as a youth.  

I would suggest that you ask both your pediatrician and your plastic surgeon  to write a letter of appeal to them.  You should not accept no for an answer.  You need someone to advocate on your behalf (parent, physician, relative) or take the matter to them yourself. 

Good Luck,

Dr. Hargrave

Douglas Hargrave, MD
Albany Plastic Surgeon
5.0 out of 5 stars 15 reviews

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