I Am 17 Years Old and Hoping to Get Surgery Before College. Will Insurance Cover it? (photo)

I started developing breasts very early and in 7th grade I was already a C/D. I am now done growing according to my doctor and I am a 32DDD/E. I am 5'7" and 126 lbs. Would it be possible for this to be covered by my insurance? I have experience pain in my rib cage and neck and have poor posture.

Doctor Answers (14)

Insurance coverage for breast reduction

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Every insurance plan has there 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 117 reviews

Insurance coverage for breast reduction

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Breast reduction may be covered by insurance if you meet certain critera, specified by your insurance coverage.  Often times, insurance company will need documentation of back pain, shoulder pain, photos, your height and weight, size of your breasts and proposed weight of breast tissue that would be removed.  If you do not meet the criteria set by your insurance coverage, you will need to undergo breast reduction by self-pay.  Your self-pay breast reduction cost will differ depending on your surgeon's fee, facility fee, and anesthesia fee.  There is a geographic difference as well.  It will vary from $8000-$10,000.  Please visit with board-certified plastic surgeons to discuss the overall cost as well as potential risks, alternatives, and benefits.  Good luck to you.

Sugene Kim, MD
Houston Plastic Surgeon
4.5 out of 5 stars 38 reviews

Breast reduction for rib and neck pain

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Yes, insurance does cover breast reduction provided that it is a covered benefit on your plan and you meet the criteria your insurance company requires.  See a board-certified plastic surgeon in your area for a consultation and recommendations. Many times, the plastic surgeon's office can submit the paperwork for you to your insurance complany.  I wish you well. -Dr. Wendel

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 36 reviews

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Breast Reduction

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Insurance may cover breast reduction for some women. It depends on the patient’s breast size, body type, and symptoms. Most insurance companies have a formula based on your height, your weight, and how much your surgeon estimates will be removed. Usually removal of about a pound from each breast is required for insurance coverage.
Health care providers are mercenary about denying coverage for breast reduction. They don’t care if your clothes don’t fit or you can’t exercise. In my experience, they don’t even care about your pain and discomfort, much less psychological embarrassment. It all boils down to your height and weight versus how much breast tissue will be removed. You can’t necessarily pick your desired breast size or shape. To remove less than the insurance company’s formula requires places the procedure in the realm of cosmetic surgery. That means you pay the bill.
Your surgeon should get a detailed medical history because some health- care providers demand a history of treatment for back pain to authorize coverage. I measure the breasts and often take photographs to be mailed with the insurance letter. If I don’t comply with the rules, the insurance provider— who holds all the cards—may not authorize paying for the procedure.  All the best!  Dr. Joe

Joe Gryskiewicz, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 40 reviews

Breast Reduction and Insurance

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It is very possible that your insurance would cover breast reduction surgery for you. Most insurance companies require that you have a minimum of 500 grams removed from each breast and for most women that would be a size DD. Also, the insurance company is looking for documented complaints such as back, neck and shoulder pain. They will want to know what steps you have taken to remedy your symptoms such as physical therapy, good support bras and taking analgesics so having any supporting information from your doctor is very helpful.

 

Getting pre-authorization can be tricky but your plastic surgeon’s office should be able to assist you. When going in for a consultation, be sure to have a parent with you since you are 17. If breast reduction surgery is a covered procedure under your policy you should be able to get approval. If you get denied ask your surgeon to appeal, it will most likely get reviewed by a doctor who will discuss your case with your surgeon. Many times I have been able to get coverage for my patients this way. Good luck!

 

 

 

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 29 reviews

Breast reduction surgery in a 17 year old

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You may very well be an excellent candidate based on your size and symptoms. However, this will need to be sorted out with one or more consultations with board certified plastic surgeons. There are many issues to consider medically. Obviously, you will need a parent involved right now with that decision.

Insurance issues would be based on your policy and if it even covers breast reductions in general. If there is the possibility of coverage, your plastic surgeon can help review what it would take to obtain authorization for breast reduction surgery.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 20 reviews

Breast reduction

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Bresat reduction surgery is sometimes covered by insurance. you have to check with your insurance company to see what their criteria are.  Many times you need medical records of recalcitrant back and neck pain to have it covered, along with an estimate of the volume to be removed.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Breast reduction coverage begins with predetermination

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Coverage for breast reduction can be very difficult depending on your particular insurance plan. The process begins with a careful consultation with a plastic surgeon and the surgeon will send a letter of predetermination to your insurance to investigate coverage available to you under your policy. Despite symptoms or problems you might have, your plan will spell out what is required.

Best of luck, peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 28 reviews

Breast Reduction Surgery and Insurance Coverage

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Dear KatieK58,  Not all insurance policies cover the costs for a breast reduction procedure.  One of the most important steps you can perform is to read the covered benefits section of your insurance policy.  This is even more important than actually calling the insurance company itself.  Every policy is written differently depending on who you get your insurance through.  When you call the insurance carrier, often you will get a "generic" answer which may or may not be correct.  The best thing is to actually read the policy.  If breast reduction is not a covered procedure, then you can expect to have to pay the costs for the procedure out of your own funds.

If your insurance carrier does cover breast reductions, then you will have to meet certain criteria for the insurance company to consider covering your procedure.  Dr. Gutowski gave an excellent summary on the how to prepare for your consultation and collecting the information your plastic surgeon will need to obtain approval for your breast reduction.

Remember, the most important first step is to read your insurance policy.  Good luck.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.0 out of 5 stars 18 reviews

Insurance Coverage for Breast Reduction for a 17 Year Old

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You should be able to be considered for a breast reduction if you meet certain criteria. Call a Board Certified plastic surgeon or get a referral from your primary care doctor.

You may want to ask the surgeon's office ahead of time if there is anything else they would like you to bring (insurance information, name of primary care physician). For breast reduction surgery, it would be good to find out what criteria your insurance company requires to approve the surgery and have it available at the time of consultation. This includes:

 

  • Symptoms such as neck, back, shoulder pain, headaches, hand numbness, breast pain, rashes under the breasts, poor posture.
  • Documentation from your primary care doctor of these symptoms
  • Documentation that you tried 6 months of physical therapy to improve these symptoms
  • Other requirements based on your insurance company's protocol
  • Results of your last mammogram or other breast studies (if you had any)

 

 

 

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

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.