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I Am 5'4" 110 and Have a 32dd Chest. Why Won't my Insurance Cover It?

asked 1 year ago by 975917anon in california
Latest answer by Tom J. Pousti, MD
Question viewed 804 times
Tags: 110-129 lbs, 5 ft 4 in to 5 ft 7 in, DD cup, insurance

My shoulders, neck and back are always hurting. I'm a petite woman and I can't afford thousands of dollars for a surgery. I don't understand why health insurance won't cover it. I understand why they wouldn't cover a breast enlargement, however, to reduce the size, it would benefit my health and well being. What am I supposed to do? I feel like I have no options.

12 answers to I Am 5'4" 110 and Have a 32dd Chest. Why Won't my Insurance Cover It?

Insurance Coverage for Breast Reduction

Insurance Coverage for Breast Reduction Answer by George J. Beraka, MD Manhattan Plastic Surgeon 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)... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast Reduction and Insurance Coverage?

Thank you for the question. There is no way of an online consultant knowing why your breast reduction coverage was denied. Corresponding with the insurance company however may be helpful. It may be necessary to appeal the denial. Otherwise, it may be necessary to change your insurance plan. Sometimes persistence pays off; continue to be a “squeaky wheel”. Best wishes.

Tom J. Pousti, MD
San Diego Plastic Surgeon

Breast reduction

Every insurance company is different a d some plans specifically exclude breast reduction as a covered benefit. Other plans require a long period of physical therapy prior to approval.

David L. Abramson, MD
New York Plastic Surgeon

VIDEO ( breast reduction)

Schedule an appoointment with a plastic surgeon and have them compose a predetermination of benefits letter to your insurance carrier. see video

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Insurance coverage of breast reduction

The short and nasty sounding answer is that you gave control of your health care needs to a third party and they now get to decide what you can and can't have. You can imagine how this might work with the federal government bureaucracy managing your other health care needs and decisions. If you asked an insurance company or the government to pay for your groceries you would run into the same thing in terms of what you want and feel you need and what they would let you have or pay for... more

Scott L. Replogle, MD
Denver Plastic Surgeon

Insurance and breast surgery

Each insurance company is a bit different when it comes to coverage for a reduction. You have to contact your insurance company with regards to their requirements.

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance coverage for Breast Reduction

If you have documented symptoms such as back pain, neck pain, and shoulder pain from large breasts, sometimes insurance companies cover breast reduction surgery. It depends on your health insurance policy as well as findings from your doctors. I would ask your insurance company if it is a covered benefit and see a plastic surgeon on your plan.

Hayley Brown MD
Henderson Plastic Surgeon

Breast reduction insurance coverage

In answer to your question: My shoulders, neck and back are always hurting. I'm a petite woman and I can't afford thousands of dollars for a surgery. I don't understand why health insurance won't cover it. I understand why they wouldn't cover a breast enlargement, however, to reduce the size, it would benefit my health and well being. What am I supposed to do? I feel like I have no options. Insurance companies do whatever they can to avoid their responsibility... more

Darrick E. Antell, MD
Manhattan Plastic Surgeon

Insurance Problem in Petite Women

Insurance coverage of breast reductions has long been diificult. I feel that petite women are at a disadvantage. Make certain that your insurance policy does not have an outright exclusion for reductions. If not, I have sometimes had success by involving state insurance commissioners.

John Whitt, MD
Louisville Plastic Surgeon

Insurance coverage of Breast Reduction - Don't give up!

Dealing with insurance companies can be a daunting and intimidating experience for the individual patient. This is an instance where your doctor needs to go to bat for you to obtain the necessary authorization. It begins with a letter documenting typical symptoms of neck and back pain, rash under the breasts, occasional numbness of the small finger, and bra strap grooving. Some insurance companies want to see evidence of failed medical management (physical therapy and/or NSAIDS)... more

Kirk A. Churukian, MD
Los Gatos Plastic Surgeon

Its probably your plan

Unfortunately, you are probably an excellent candidate for a breast reduction but due to a clause in your plan it's not covered. As said before, every plan has a contract that specifies the plan's exclusions and covered items. Many plans have resorted to excluding any type of breast surgery except for reconstruction after mastectomy for breast cancer. Speak to your HR dept at work if that who you have your insurance through or look at a copy of your plans... more

Steven Schuster, MD
Boca Raton Plastic Surgeon

www.schusterplasticsurgery.com

Breast Reduction coverage is in the details of your plan

It sounds like you have all the classic symtoms to do well with a breast reduction. By your size and symptoms you would benefit from a breast reduction. Insurance companies, however, have you under a certain contract. You need to look at the details of your plan and talk with a policy administrator and ask what their criteria are for breast reduction coverage. You may find that you are not paying for breast reduction coverage and it is excluded from your policy... more