Will Insurance Cover Breast Reduction for H Cup Breasts?

asked 2 years ago by Karim in Wood Cross Utah
Latest answer by Tom J. Pousti, MD
Question viewed 699 times
Tags: back, breasts, neck, shoulder, after pregnancy, breast size, insurance

I have been suffering for years with back, neck, and shoulder pain due to the size of my breasts but never got surgery due to lack of insurance and I wanted to have a child first.

Now, I have had my child which has caused my breast to be even larger now they are a size 42 H. I have medicaid but it is the blue card(non traditional medicaid), what would I have to do to get Breast reduction covered?

6 answers to Will Insurance Cover Breast Reduction for H Cup Breasts?

Breast reduction coverage

You may want to read my answer here so that I avoid being repetitive: http://www.realself.com/question/breast-reduction-insurance-coverage In most instances with private insurance, your doctor can submit a letter of predetermination of benefits to ascertain if your procedure is covered. However, Medicaid does not accept or review these letters so that is a moot point. In general, its sounds as if the amount of reduction would be reasonably covered in your particular situation.... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Insurance criteria for Breast Reduction coverage

Every insurance company has specific criteria that they use to determine the medical necessity of a breast reduction. This is based on multiple factors and differs from insurance company to insurance company (and from state to state in the case of government plans). The things that they will look at are primarily the symptoms you are having related to your large breasts, the different non-surgical remedies you have tried (eg chiropractor, medications, physical therapy, etc.), your height,... more

Jason Brett Lichten, MD
Columbus Plastic Surgeon

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

Insurance and breast reduction

Insurance does not always cover a breast reduction. The best thing for you to do would be to call yoru insurance company and ask for their criteria to approve them. Then seek a doctor that will accept Medicaid.

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance coverage for breast reduction.

Insurance Coverage for Breast ReductionView Edit Answer by George J. Beraka, MDManhattan Plastic SurgeonContact the doctor80% 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... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Insurance coverage for breast reduction

Insurance coverage has gotten more difficult over the years. When I started my practice, most of my reductions were covered by insurance. Now most are not. Lifting the breast and reducing the size helps with back pain, neck pain, shoulder notching, rashes and infections of the skin under the breast, and posture. It also helps with ease finding clothes and ability to exercise. Check with insurance to see if “reduction mammaplasty” is a covered surgery with your plan. All plans... more

Lauren Greenberg, MD
Palo Alto Plastic Surgeon

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