Will Insurance Allow Breast Reduction from F to D Cup?
- Asked by GarrisonJ in Texas
- 4 years ago
I have always been large breasted and have always wanted a reduction. In the past 2 years, I have given birth to two children and breastfed. My youngest is now a year old and my breast have not returned to "normal" size. I am still wearing my maternity, size F bras. My back and neck hurt all day long. As I said earlier, I have always been large breasted. Will insurance allow me to be a size D, or must you go really small? Am I a good candidate for insurance to cover my breast reduction? I am 33 years old, 5'7", and 165 lbs.
Breast reduction and insurance coverage
Hi, insurance companies are notoriously difficult when it comes to coverage for a breast reduction. Every company has a different standard, but in general they want to see a minimum amount of tissue off per breast prior to agreeing to coverage. You look and sound like you would be a good candidate to be covered by most companies. I would suggest calling your insurance company to check their policy. When you see your surgeon, his or her office should be able to facilitate sending in the request for coverage. Make sure the insurance company sends you something in writing if they agree to cover the surgery; the last thing you want is a surprise bill after surgery. Good luck, /nsn.
Candidates for breast reduction
Based on your height, weight, and breast size, you look like an excellent candidate for a breast reduction. Criteria differ but most insurances require 500 grams be removed from each side. This equates to one pound per side. What cup size this equates to is not possible to say.
Many plastic surgeons no longer work with insurance and as such are not constrained by these size restrictions so the reduction can be customized to the size you want and not just to achieve a weight reduction.
Web reference: http://www.randcosmeticsurgery.com
Insurance and breast reduction
Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.
Recent Breast Reduction Reviews
Breast Reduction Photos
Breast reduction and insurance coverage
I believe that every Plastic Surgeon would consider your request very appropriate considering your current breast size. The decision rests with your insurance company, however, and this often is a challenge for the well deserving patient. Always use the advise of your local Plastic Surgeon in trying to increase the possibilities for approval for your request. You may be asked to try to lose some weight, engage in physical therapy or chiropractic care for a period of time to show that conservative measures have been considered.
If all else fails and it is not covered, be aware that you still can move forward with the operation and should expect a good result.
Good luck to you.
Frank Rieger M.D. Tampa Plastic Surgeon
Web reference: http://w.w.w riegercosmeticsurgery.com
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 board-certified plastic surgeon. Good luck!
If breast reduction is performed to improve functionality by relieving pain in the
neck, shoulders and back, or to relieve chronic infections where the breast meets the skin of the chest wall, then insurance may cover the procedure. Often the insurance coverage will depend on how many grams of breast tissue are removed in the reduction, but you appear to be someone who would qualify on that basis. Each insurance company has heir own criteria to determine coverage, and you will need to work with the plastic surgeon you consult with to obtain pre-approval for the surgery. If you have seen another physician for symptoms related to your breast size, careful documentation of those encounters, as well as good "pre-operative" photographs, can help you obtain pre-approval for the surgery.
Web reference: http://www.plasticsurgeryweb.com
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.
Insurance coverage for breast reduction.
Insurance Coverage for Breast Reduction
Answer by George J. Beraka, MD
Manhattan Plastic Surgeon
Contact the doctor
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 little more than a pound) or more are removed from each breast.
4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.
5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.
6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.
7) Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.
8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.
9) Don't give up. If the first request is denied, demand an appeal.
10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.
Medical insurance coverage varies between plans
Although you appear to be an excellent candidate for breast reduction, whether your insurance will pay for it depends entirely on your plan. Insurance coverage varies between companies, and even between different plans in the same company. Generally, however, most plans will cover breast reduction if the following criteria exist:
1) Back pain (from breasts being too big)
2) Bra strap grooving on the shoulders.
3) Rash in the lower breast fold that does not respond to medical treatment.
4) Your surgeon believes that a minimum amount of tissue can be removed (usually 500 gms per side, sometime less)
Breast Reduction Insurance Coverage in Texas
Most of the plans I have worked with will allow a reduction if we are anticipating removing over 500 grams of tissue. For reference, a can of soda is about 350 grams.
The only way to tell is have your PS call your INS company and check your benefits. At my Houston practice, I perform breast reduction through a short lollipop-shaped scar, instead of the older anchor-technique. Some photos at:
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.