Yes, Blue Cross Blue Shield insurance will cover breast reduction if you meet certain criteria. Individual policies will vary from state to state. Generally, the removal of 500 grams of tissue is required per breast. Fortunately, for small women like you, the Schnur Sliding Scale was developed. With the Schnur Scale, your body surface area will be used to calculate how much tissue is required for insurance to consider the procedure medically necessary.
I would recommend you obtain a consultation from a board certified plastic surgeon. He or she will be able to send your information to your insurance company for preapproval. If certain conditions are met, the surgery will be approved for insurance coverage.
In Alabama the BCBS policy is as follows (copied from the BCBS website):
"Reduction mammaplasty meets Blue Cross and Blue Shield of Alabama’s medical criteria for
coverage for women aged 18 or older or for adolescents whose breasts are fully developed; i.e.,
patient has maintained current height, weight, and breast size for 12 months, when:
- a minimum of 500 grams of breast tissue is to be removed from each breast; OR
- a combined minimum total of 1000 grams of breast tissue is to be removed from both breasts (effective 10/01/2012); OR
- a women is of small stature (5 feet 3 inches and under), consideration will be given for removal of less than 500 grams of breast tissue from each breast using the Schnur Sliding Scale chart. Body surface area is calculated and then the Schnur Sliding Scale chart is used to determine the number of grams to be removed from each breast.
And two or more of the following medical indications are met:
- Pain in the upper back and shoulders resulting in documented treatment and interference with activities of daily living. This pain should be evaluated to determine that it is not associated with another diagnosis such as arthritis. The pain is not relieved by conservative therapy including an appropriate support bra, exercises, heat/cold treatments and appropriate non-steroidal anti-inflammatory agents/muscle relaxants.
- Dermatitis of skin of shoulder or shoulder grooving not responding to conservative treatment, including support bra.
- Intertrigo between the pendulous breast and the chest wall
- Sternal notch to nipple measurements of 26 cm or greater"
(Obtained from BCBS of AL Reduction Mammaplasty Policy #056, November 2013)
Trey Aquadro, M.D.