I am a 40 woman with a 4"11 and a 34DD (doesn't really fit properly.) I weight 120 lbs. I love doing outdoor sports or exercise/running but my breasts size prevent me from doing all that. I have bcbs California. Will my bcbs pay/qualify for my breast reduction? By the way, I live in Orange County California. Thank you.
I Am a 40 Woman with a 4"11 and a 34DD- reduction covered?
Doctor Answers (7)
Read your contract if they "exclude" breast reduction.
If "not" you can check on the BC/BS websites in many States where the "criterias" are listed for "prior approval" of breast reduction. This you can check befor you see a Board Certified Plastic Surgeon. Ultimatley he is the one who can determine if you are a candidate for an insurance covered Breast Reduction and submit a request for insurance coverage of the procedure.
Breast Reduction San Diego, CA
Read your BC/BS contract to learn about the criteria they consider when determining whether or not reduction mammaplasty is a covered benefit. A desire to be more comfortable when active is usually not considered. Severe, disabling, intractable back, neck, and shoulder pain unresponsive to medical management, skin rashes and/or open wounds beneath the breasts, postural backache, and removal of a certain weight of breast tissue are common benchmarks. Although the above factors are not completely and exclusively scientifically valid, they show up in many of the guidelines I've seen from third party payers.
Insurance coverage for breast reduction surgery
The short answer is "only your insurance company knows for sure." Policies vary in what they cover so the only way to know is to see a board certified plastic surgeon who will talk to you, examine you, discuss the surgery with you and then write a letter to your insurance company to see if your policy will cover the planned procedure. Some insurance companies have requirements for surgeries that they cover such as a trial of non-surgical treatment or amount of tissue that must be removed. With that said, you do sound like an excellent candidate for a breast reduction. Good luck.
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Breast reduction coverage by insurance
Your breast reduction may be covered by insurance depending on how much tissue needs to be removed during the surgery. Often times Blue Cross may require close to 500 grams of tissue to be removed (per side) for the surgery to considered "reconstructive". Typically your surgeon will examine you and submit photos to the insurance company, who will then determine if your case will be covered by insurance. If you are a DD bra and would like to be decreased to around a B/C, that just may be enough tissue to satisfy the insurance companies.
Each insurance plan varies greatly, so it's difficult to predict your coverage without examining you in person.
A board certified plastic surgeon can help determine if you are a good candidate.
Sounds like you are very active and I have helped many patients in similar situations. Unfortunately, we won't know if insurance will cover this procedure until you send in a letter for authorization. I see patients in the office and then send a letter along with photos to the insurance company asking for authorization for surgery. If you have letters from a chiropractor or any other doctor who state that this is causing you discomfort, etc.. it is smart to send those along with the authorization to the insurance compnay. I hope this is helpful.
Will insurance authorize coverage for a breast reduction
It surely sounds like a breast reduction would be quite beneficial for you in many ways. Whether or not you can obtain insurance approval for the procedure is a different story however. First, you need to make sure that your particular plan covers this procedure as some plans specifically make breast reduction an exclusion from coverage.
Given the parameters that you provided (though without photos), you may very well qualify for coverage if it is available. You should see a reputable plastic surgeon in your area who can do a full evaluation and then seek preauthorization from the insurance company. Most insurance companies require that a certain volume be removed (based on your weight) in addition to other documented symptoms such as neck, back and shoulder pains; shoulder grooves from your bra; skin irritation and rashes; orthopedic or chiropractic care, etc. Letters from other health care providers can also be helpful in obtaining approval such as a primary care physician, a chiropractor and physical therapist.
Insurance for breast reductions
The best way to find out if your insurance covers a procedure is to ask your insurance company. They might, but in most situations a letter from a plastic surgeon who has examined you will be needed, too. Pre-authorization might be needed. You might have to exhibit certain symptoms. They might ask for various things to be tried first before surgery is approved, such as being properly fitted for a bra, a trial of NSAID medication, physical therapy for your back and so on. In addition there might be minimum removal requirements before they pay for the procedure.
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.