How Does Someone Qualify For An Insurance Approved Breast Reduction?

asked 8 months ago by cneedshelp in Houston, TX
Latest answer by Sugene Kim, MD
Question viewed 312 times
Tags: coverage, F cup, G cup, insurance

I am currently a 32G up from a 32F pre-pregnancy. I find myself with extreme upper back pain at night when I sleep. My bras are very uncomfortable. I am 5'4 130 pounds pre-pregnancy (currently 151 at 24 weeks pregnant). I am wanting to see if you think I might qualify for insurance approve breast reduction. I find my self having to get massages every month to 2 weeks just to maintain.

9 answers to How Does Someone Qualify For An Insurance Approved Breast Reduction?

Qualifying for coverage for breast reduction

Whether breast reduction is covered by insurance is depedent on each patient's physical symptoms, characteristics as well as types of insurance that she carries. Unfortunately, it is getting harder to get breast reduction covered by insurance. Please review your insurance policy in regards to breast reduction. You want to have documentation of your symptoms (back pain, shoulder pain, shoulder grooving, rashes). Insurance companies may also want your... more

Sugene Kim, MD
Houston Plastic Surgeon

If the insurance company considers breast reduction medically necessary

I have reviewed requests for over 20 years from numerous insurance companies as to whether breast reduction will be covered. Insurance companies will cover a medically necessary procedure. They have certain criteria that need to be met, to make it medically necessary. Some of these criteria include a documented history of neck and shoulder pain, a one year documented history of recurrent infections developing underneath the breast from moisture accumulation that have been treated by a... more

Joseph M. Perlman, MD
Houston Plastic Surgeon

Breast reduction insurance coverage

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 letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you're saying a well-trained/experienced... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Insurance criteria for Breast Reduction surgery

Hi, Certain criteria has to be met before insurance approval. Call your carrier and find out what these are. FYI, the more documentation you have that your large breasts are causing you trouble, ie. back, neck, shoulder pain, headaches, decreased quality of life, difficulty sleeping- exercising, rashes, etc., the more likely you are to be approved. These symptoms should be documented by your OB-Gyn, primary physician, pain specialist, chiro, spine specialist, orthopedist, etc.... more

Gary M. Horndeski, MD
Houston Plastic Surgeon

www.horndeski.com

Insurance coverage for breast reduction.

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points. 1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches. 2) Very big reductions (like from an F cup to a C cup) will usually be covered. 3) Many policies will pay for breast reduction if 500 grams (a... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Questions about insurance coverage for a breast reduction

You may very well be able to have your insurance cover your breast reduction. However, criteria and even coverage in general depends on your particular insurance company and the specific plan. Some plans have an outright exclusion for breast reduction period. Insurance plans have various criteria that you would have to meet in order to be able to get authorization for the surgery. What is required varies among the different insurance companies and can include a specific amount of breast... more

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon

www.turkeltaub.com

Breast reduction insurance approval

The most important part of getting qualified for breast reduction surgery is having a history of evaluation and treatment for your symptoms of enlarged breasts. Almost all insurance companies will require documentation to prove you have the expected symptoms of large breasts. Insurance companies want to make sure they are not paying for a cosmetic procedure; they want to improve your symptoms and ability to function. After you have established a record of treatment for... more

Marcus L. Peterson, MD
Saint George Plastic Surgeon

Insurance coverage for breast reduction

Insurance coverage for breast reduction varies by insurance carrier and plan. In addition to large breasts and symptoms such as back, shoulder and neck pain, grooving in the shoulders caused by bra straps and recurrent rashes between or beneath the breasts. While your breast size and complaints would probably meet these criteria, insurance carriers may also require a period of conservative treatment. This may include physical therapy, medications, etc. After you... more

Craig S. Rock, MD
Houston Plastic Surgeon

www.drcraigrock.com

Breast reduction in patients who have symptoms due to the large size of their breasts will

Often qualify for insurance coverage. While each plan has its own variations, and approval needs to be determined before surgery, you sound like someone who would meet the criteria for coverage of most plans. Specifically, symptoms such as back, neck or shoulder pain, deep grooves under the bra straps, and recurrent infections where the skin of the breast meets the skin of the chest wall under the breast are factors that can establish the need for surgery. If you have seen... more