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Hello, I am a 20 year old woman, currently a size 38DDD, will insurance cover a reduction and lift? (photo)

I am looking to be a 36C. My biggest size was a 42G and I recently lost a lot of weight over the course of a year, it played a significant role in the texture and density of my breasts. I'm 6'2, 187lbs. My breast fold and are wrinkly. I have no children. My back is in constant pain, with or without a bra. Only relief is laying down. Psychologically, I fear social and intimate settings because I am worried about people seeing them or spillage. I need insurance coverage.

Doctor Answers (8)

Breast Reduction and lift after large weight loss

+2
Yes, A Breast Reduction and lift will be an excellent solution for you.  I do not know how your insurance company will evaluate and assign benefits?  I can tell you that a breast reshaping will be life changing.


Charlotte Plastic Surgeon
4.5 out of 5 stars 19 reviews

Coverage for breast reduction

+2
Every insurance company is different. The same company may be different on how they evaluate each case. they really try not to cover procedures. Usually you need to be larger than a DD, less than 180 pounds, and you may need to have physical therapy for up to 6 months to strengthen your shoulder muscles to help avoid surgery. they figure most women will drop out.
You may have a deductible and co pay that apply even if covered. Most surgeons have discounted rates for cosmetic rather than insurance for breast reductions. The fees may not end up that different and then you can proceed how you want.
I would suggest you get a consultation from a board certified plastic surgeon in your area that performs this regularly and go from there. Do you research so you pick someone good. Look at results, etc.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 10 reviews

Does insurance cover the cost of a breast reduction?

+1
The answer is yes. If you have symptoms of back pain and shoulder pain and you can document that you have been complaining about these problems to your doctors the insurance will consider the operation functional and non cosmetic. You have to be properly evaluated by a board certified plastic surgeon. We normally take pictures and write a letter on the patients behalf to the insurance company and wait for a response before the surgery. It is best to send all the documentation at once to expedite the process. You first step is to make an appointment.

Farhad Rafizadeh, MD
Morristown Plastic Surgeon
5.0 out of 5 stars 25 reviews

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Are you a breast reduction candidate?

+1
If your breast are 38DDD in size, you sound like the perfect candidate for a breast reduction to relieve the symptoms that you are mentioning.  First check with you insurance company to see if the surgery is a paid benefit.  Next set up a consultation with a board-certified plastic surgeon to confirm that you are a candidate for the surgery.  Your doctor will then write a letter of prior authorization to your insurance company asking for coverage for your surgery.  Once you hear back from your insurance company that it has been pre-approved, you should be able to schedule your surgery.  Best wishes to you, it is an amazing surgery for relief of the symptoms that you are having.   

Joe Gryskiewicz, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 65 reviews

Hello, I am a 20 year old woman, currently a size 38DDD, will insurance cover a reduction and lift?

+1
Your first step is to secure health insurance. Next check with said insurance if breast reduction is a covered benefit. Third, What are the requirements or citeria to obtain this coverage. Fourth, see a boarded Plastic Surgeon to help you address obtains the coverage approvals. Good Luck.. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 64 reviews

Hello, I am a 20 year old woman, currently a size 38DDD, will insurance cover a reduction and lift?

+1
Congratulations on your significant weight loss; many patients who experience significant weight loss benefit from some degree of breast reduction/lifting surgery. Online consultants, without the benefit un clothed photographs, will not be of much specific help to you. At some point, you will benefit from in person consultation with board-certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals carefully as well.
Your plastic surgeon will be able to approach your health insurance company on your behalf. Remember that breast reduction surgery is one of the most patient pleasing operations performed as you go through the, sometimes challenging, interaction with the health insurance companies. Prepare to be persistent.
Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 791 reviews

Insurance coverage for breast reduction

+1
You could very well get insurance coverage for a breast reduction. It will all depend upon your history, documentation, and your particular insurance policy. The surgery itself is a great one and patients are almost universally happy with the results. Back and neck pain can almost always be significantly reduced or eliminated for patients that have that complaint. And the surgery also provides a dramatic cosmetic improvement for most patients. You need to have a consultation with a plastic surgeon to start the process.

William T. Stoeckel, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 44 reviews

Insurance coverage for breast reduction

+1
Insurance companies can be maddening and their decisions hard to understand. It may be that your insurance company will allow you to have a reduction that is covered but will demand that your surgeon remove a certain volume or weight of tissue regardless of how that will make you look.  Insurance coverage for a breast reduction is often more expensive than you might think.  You will get separate bills from the hospital, surgeon, anesthesiologist and pharmacy.  These bills add up quickly and can often come very close to what it costs as an out of pocket surgery.  Additionally, if an out of pocket expense, you and the surgeon can make a plan that helps you look the way you want to look, not the way your insurance company wants you to look (they don't care what you look or feel like).
Best,
Dr. Pyle

Jeremy Pyle, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 27 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.