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Will Blue Cross Blue Shield Cover Breast Reduction?

asked 2 years ago by Kayla08 in Illinois
Latest answer by Miguel Delgado, Jr., MD
Question viewed 28,396 times
Tags: Blue Cross/Blue Shield, DD cup, insurance

Will Blue Cross Blue Shield cover any of the expenses of a Breast Reduction? I'm 19 years old, 5'1" tall and weigh 115 pounds. My cup size is a DD.

My back gets a few sharp pains in it and if I try to straighten out my shoulders so they don't slouch it hurts between my shoulder blades. My breasts make my body entirely unproportional so if you have any advice for anything I'd appreciate it!

16 answers to Will Blue Cross Blue Shield Cover Breast Reduction?

Breast Reduction and Insurance

Blue Cross Blue Shield has different requirement depending on state and insurance plan. The process to receive insurance reimbursement for the breast reduction procedure can be quite frustrating. Moreover, different insurance companies generally have different requirements. There are a series of questions that must be answered prior to beginning the insurance process. 1. Have you experienced persistent symptoms in at least two of the anatomical body areas below, affecting daily... more

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon

Reduction mammoplasty (breast reduction)

BCBS uses a scale called the schnur scale (http://www.bcbst.com/MPManual/The_Schnur_Sliding_Scale_chart.htm to evaluate candidates for this procedure. Given your height and weight you have a body surface area of 1.5 which means that you should have at least 260 grams from each breast to be removed in order to be considered eligible for coverage. This is the equivalent of approximately 6-7 ounces.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Blue Cross Blue Shield May Cover Breast Reduction Surgery

It is very possible that your insurance may cover your surgery, but the only way to find out for sure is to have your plastic surgeon request pre-authorization for you. BC/BS has different types of policies and some may have coverage and other do not, so it will also depend on what particular policy you have. Most insurance companies that do cover the procedure require that a minimum of 500 grams per breast is needed to be removed, and usually that would be a double D. Also they want to know... more

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon

www.dr-delgado.com

Breast reduction insurance coverage

Based on your description you may be a good candidate for breast reduction surgery; for physical and emotional reasons. 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... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Will insurance cover my breast reduction?

AAARGH. It is harder now than 5 years ago to get breast reductions covered by insurance. Most follow the Schnur scale, which requires a certain number of grams be removed. You also should document any other treatments for neck pain or back pain including medication (like Advil, or stronger meds), physical therapy, chiropractor appointments, etc. At age 19, you likely don't have many other treatments. For an in depth letter which reviews all the points they look... more

Lauren Greenberg, MD
Palo Alto Plastic Surgeon

Breast Reduction and Insurance

Check with your insurance company to determine if this is a covered benefit under your specific plan. This information can also be obtained in your policy booklet. best wishes!

Christine Sullivan, MD
Columbus Plastic Surgeon

Insurance coverage for breast reduction

Each insurance company has different criteria for pre-approval of a breast reduction surgery and you should contact your carrier. Check with Empire.

Steven Wallach, MD
Manhattan Plastic Surgeon

Talk to your insurer.

You will find out much more by speaking directly to your insurer yourself. My experience in this regard has been so frustrating. Hopefully you will have better luck. Remember, be sure to trust your care to a board certified plastic surgeon. If your insurance ultimately refuses to cover the procedure, he or she will be able to give you the best advice on your next step.

Brian K. Brzowski, MD
Salt Lake City Plastic Surgeon

Insurance coverage for breast reduction.

Hi. I wrote a long article about insurance coverage for breast reduction which I think you will find helpful. Please read it at the bottom of my RealSelf profile.

George J. Beraka, MD
Manhattan Plastic Surgeon

Blue Shield will most likely cover Breast Reduction

Most likely BC/BS will cover your surgery. Consult with a plastic surgeon (I recommend a board certified plastic surgeon by the American board of plastic surgery, the only board in plastic surgery by the American Board of Medical Specialties). This doctor will examine you and document that you are a good candidate for the procedure. He will send a precertification (request for approval for surgery) letter to your insurance and after 4 to 6 weeks the insurance will respond, either approving... more

Victor Manuel Perez, MD
Kansas City Plastic Surgeon

Insurance coverage for Breast Reduction in Maryland

In Maryland, insurance benefits and coverage vary with each insurance company and with each policy. During your consultation, your surgeon will help you determine if your breast reduction surgery would be considered for an insurance claim. First you’ll need to check with your insurance provider as to what their criteria for breast reduction to be considered a medically necessary covered procedure. If pre-authorization is required then you can expect to wait 4 weeks to 8 weeks for a... more

Ricardo Rodriguez, MD
Baltimore Plastic Surgeon

Insurance coverage of breast reduction surgery in Los Angeles

Insurance companies in Los Angeles and California have stringent requirements for insurance coverage of breast reduction. On iniitial consultation, I document the functional and anatomic characteristics that may predispose to back pain, neck pain, and inframammary irritiation.

Raffy Karamanoukian, MD
Los Angeles Plastic Surgeon

Blue Cross Coverage of Breast Reduction

Blue Cross policies vary widely among states and even within the same state for their requirements to cover breast reduction surgery. All ins. cos. look at the symptoms that you are experiencing and the estimate of breast tissue to be removed. Assuming that you have BC/BS of Illinois, I have found them to be especially difficult to deal with in obtaining coverage for reductions. You do sound as if your surgery should be covered, so keep fighting until you have exhaused all appeals.... more

John Whitt, MD
Louisville Plastic Surgeon

Insurance coverage for Breast Reduction a common concern

A very common concern. I just received an approve no guarantee letter from BCBS of Fl. It took 2 months after I sent them a predetermination letter with the patients photos and history. So go see a boarded Plastic Surgeon in your area that is in network for your insurance. Their office will know exactly how to get you approved. Remember there is always out of pocket expenses, no insurance covers any operation at 100%. Best of Luck!

Darryl J. Blinski, MD
Miami Plastic Surgeon

Blue Cross Blue Shield coverage for Breast Reduction

This is a very commonly asked question on this forum and I would pay close attention to what Dr. Placik has to say. As a Chicago plastic surgeon, I am sure he knows the ins and out of the system. If your particular BCBS policy HAS Breast Reduction benefits (not all do), you sound like an ideal candidate which they SHOULD cover. However, should and would are different matters. Like other insurers, they may require a formal pre-certification process with documentation of 6 months or longer of... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Coverage for a breast reduction

You should go to a plastic surgeon for an evaluation. Their office can assist you in your quest for insurance coverage. Not all plastic surgeons take insurance reimbursement anymore because it is so low, so be sure the doctor you go to does still work with insurance.