Im 21 and Have a Size 38DD Breast Size. Will Medicare Cover a Reduction?

asked 1 year ago by lucy222 in Harrison, NY
Latest answer by Tom J. Pousti, MD
Question viewed 1,211 times
Tags: age 18-24, 150-169 lbs, 5 ft 0 in to 5 ft 3 in, DD cup, insurance, medicare

im 21 years old and im 5'3 about 150 pounds and i have a breast size of 38DD and i get back pains and shoulder pains even when i stand for a long time. can you tell me if medicare/hudsonhealth will cover a breast reduction?

7 answers to Im 21 and Have a Size 38DD Breast Size. Will Medicare Cover a Reduction?

Breast reduction insurance coverage

Based on your description you may be a good candidate for breast reduction surgery; for physical and emotional reasons. The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. This documentation and... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Large Breast

Breast reduction is frequently covered if the problem has been present for more than a year causes neck , back and shoulder pain and has been treated unsuccessfully non surgically. Each insurance plan varies but in your case it is probable Medicaid and not many Plastic Surgeons would take it , you probable could go to a training program and have a good job done by the residency program.

Walter D. Gracia, MD
Arlington Plastic Surgeon

Insurance covergae for a breast reduction

You should check with your insurance plan to figure out what the criteria are to get approval for a breast reduction. The requirements vary from plan to plan.

Steven Wallach, MD
Manhattan Plastic Surgeon

Breast Reduction - When will insurance pay for it?

The first question is - Are you a good candidate for Breast Reduction Surgery? Insurance will generally consider approving Breast Reductions if you have the following criteria: 1) Large breasts that create symptoms that are not relieved by medical treatment for 3 - 6 months. 2) That other causes of the pain have been evaluated - Orthopeadic or Chiropractice evaluation, and physical therapy and weight loss has been tried. 3) That you have large enough breast to remove at... more

Richard Greco, MD
Savannah Plastic Surgeon

Low reimbursement for procedures make it difficult to find surgeons

IT may be difficult to identify a plastic surgeon who is qualified and willing to accept medicaid risks. Unfortunately, even if surgeons were busy enough to do 4 a day, the reimbursements would not be enough to pay the surgeons expenses and he/she would actually lose money. I know that sounds surprising but it is a sad reality.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Medicare and Medicaid funding for breast reduction surgery

The public health care programs typically will not pay enough for surgeon fee, facility fee and anesthesia fee to make doing breast reduction surgery cost effective. In our practice, we have had difficulty getting paid at all for breast reduction surgery for Medicare patients in the past- so we just don't offer that service as an option to Medicare patients. Since you are 21 years old, you are not on Medicare- you might have Medicaid insurance. Same problem- not enough reimbursement... more

Scott Sattler, MD
Bellevue Plastic Surgeon