I'm 21, 5'3" and I Weigh 116 and Breast Size is 32DD. Can I Get Insurance to Cover Reduction?

Hi ya'll! I'm 21 years old and I weigh 116 exactly. My breast size is a 32DD and I am 5'3". My frame is so small I find myself slouching all the time. It is impossible for me to sit up straight with the weight I am carrying in front of me. I work out every single day regardless of the neck, back and shoulder pain my breasts cause me. I find my sports bra and bras eating at my flesh every day. I am miserable. Would insurance cover a situation like this and how long would the process take? Thanks!

Doctor Answers (8)

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 128 reviews

Insurance coverage

+1

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, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 40 reviews

Will insurance cover a breast reduction?

+1

Breast reduction is a life changing procedure for someone experiencing back pain or self esteem issues because of their appearance.  Depending on your insurance company, breast reduction can be either fully or partially covered. You will have to provide your surgeon as well as your insurance company with the proper documentation from your primary doctor and back specialist stating your back pain is caused by your breasts. This process can take anywhere from a couple weeks to several months depending on what your insurance company requires.  Be sure to research and meet with a board certified plastic surgeon before going through with the procedure.

Shain A. Cuber, MD
Edison Plastic Surgeon
5.0 out of 5 stars 35 reviews

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Insurance coverage for a breast reduction depends on multiple factors

+1

From the information that you have provided, it appears that you would benefit considerably from a breast reduction. However, that does not mean that you can get insurance coverage for it. The first thing that you would need to do is find out whether a breast reduction is a covered benefit as many insurance plans have made this procedure an exclusion of coverage.

Different insurance companies have varying criteria for approval for coverage. Your plastic surgeon can determine what these are and submit the appropriate information that often includes photos and even letters from other physicians, physical therapists, etc. that strongly recommend undergoing the procedure.

The time needed to obtain authorization varies among the insurance companies and can take anywhere from a few weeks to even a few months.

Good luck!

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 21 reviews

Coverage for breast reduction

+1

You may qualify for an insurance-covered breast reduction.  From the time your surgeon submits a request to the insurance company for coverage of the procedure until the insurance company answers is currently approximately 30 - 90 days in Texas.  The letter requesting coverage includes your medical history, physical examination and the weight of breast tissue planned to be removed (an amount based upon your current size and post-operative goal).  If you wish to proceed:

  1. Check the exclusions page on your insurance policy (or call the insurance company) to find out if the procedure is excluded from coverage - if it is, the carrier will not pay under any circumstances.
  2. If the procedure is not excluded, and you are interested in knowing what the insurance company will require, you can look up the "Clinical policy bulletin" on the companies website, which will list the requirements.
  3. Schedule consultations with board-certified plastic surgeons experienced at performing breast reductions, who will be able to educate you further about the procedure, as well as request authorization for the procedure from your insurance company.

Good luck.

Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 18 reviews

Breast reduction coverage

+1

Thank you for the question. Given your circumstances, you probably have a fair shot at getting your reduction covered. Most of us do submit preauthorization letters to your insurance based on your physical exam. Then, it is up to the insurance company. It's a great procedure! Good luck to you!

Jennifer Lauren Crawford, MD
Austin Plastic Surgeon
5.0 out of 5 stars 8 reviews

Breast reduction

+1
Hello. It does sound like you are a candidate for breast reduction. As another poster has said, it has a very high patient satisfaction rate. Most plastic surgeons write letters and submit photos to the insurance, assuming the surgeon accepts insurance payment for breast reduction. I presently don't believe insurance companies reimburse appropriately for the kind of detail and comforting care we plastic surgeons provide our patients with this operation. The process to obtain insurance approval, assuming it is a covered benefit and your surgeon accepts insurance, usually takes 4-8 weeks. Frequently, the insurance company will deny approval and require additional supportive documentation. That can be furnished by the primary care doctor sometimes. Good luck in your search!

Tim A. Sayed, MD, FACS
Palm Beach Plastic Surgeon
5.0 out of 5 stars 14 reviews

Breast Reduction through Insurance

+1

Thank you for your question.

Based on your description, you may be an excellent candidate for breast reduction surgery. This is one of the most patient pleasing operations we do.

Each insurance company is different with what they require to "authorize" the breast reduction surgery through insurance.  I write a letter and send photos of the patient when trying to get authorization (I am sure most plastic surgeons do this as well).  Also getting supporting letters from other doctors who can document that you have had neck, back and shoulder pain and/or rashes due to the large breasts. Supporting documentation is usually very helpful.

Visit with a well experienced, board certified plastic surgeon to start the process.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 793 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.