Will Medicaid Cover Breast Reduction for H Cup Breasts?

I am 26 yrs from New Orleans and am on medicaid. I've been to the doctor several times for my back and breasts. My right breast is longer than my left breast and I've got 48H cup breasts and weight 223 lbs with a height of 5'1".

My back hurts when I sit and stand for a long time. Do you think medicaid will pay for me to get a Breast Reduction?

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age 25-34 back breasts HH cup female 5 ft 0 in to 5 ft 3 in 200-249cc insurance reduce

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10 Doctor Answers | Asked by tootiebaby in new orleans

Doctor Answers (10)
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Breast reduction

Medicaid will probably pay for the reduction, but the larger concern is your weight. You are 100lbs overweight, which increases the risk of any elective operation. I would suggest you look into physician assisted weight loss for your general health. After losing 50-100lbs, then you may not need a reduction, and your overall health will be better.

Breast Reduction - Insurance Coverage

Probably, but you cannot assume that and, regardless, there are still some issues. And they may not approve it for you right bnow. Each insurance company is different, and each has its own rules with respect to "coverage." It used to be that a 500 gram reduction (from each side) would be enough to qualify for insurance coverage, but that is no longer the case and cannot, in any event, be assumed to be the case. You'll first have to contact your company to make sure... more

Medicaid coverage for gigantomastia

Breast reductions for H cup breasts are almost always approved with one caveat-if your insurance plan restricts coverage to women with body mass indices below a certain cutoff point, it could be denied based upon your weight. I find this requirement applicable to many HMOs but, again, there may be an exception because of the extremely large size of your breasts.

Breast Reduction Insurance Coverage?

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. It is one of the most patient pleasing operations we perform. 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... more

Insurance and breast reduction

Each insurance carrier has different criteria for pre-approval of a breast reduction. You should check with your insurance carrier.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast Reduction Under Insurance

Medicaid may cover this surgery but there needs to be a preoperative authorization obtained. You may or may not qualify just depends on what their requirements are. That is not so much an issue but finding a qualified plastic surgeon that would be willing to undertake this huge operation under medicaid payment. This surgery is already underpaid by PPO health insurance and others. Medicaid payment would even be lower than others and most qualified board certified plastic surgeons do not... more

Insurance coverage for breasts reduction surgery

Medicaid coverage will vary greatly from state to state. There may also be a weight requirement. Many times we find that Medicaid and other insurance companies require an attempt at weight loss and other non surgical modalities to see if this gives any pain and symptom relief.

Medicaid Coverage of Breast Reduction

Each state decides on their criteria for coverage of different procedures by Medicaid. I agree with others that you will have difficulty finding a private practice plastic surgeon willing to perform the procedure because of the ridiculously low reimbursement for this big operation. Your best bet is probably to try to obtain a consultation with either the LSU or Tulane Plastic Surgery Depeartment. Good Luck!

Louisiana Medicaid coverage for H cup Breast Reduction

Every state Medicaid program has its own requirements and quirks. Our colleagues in Louisiana would be your best source for finding out if your operation will be paid for by them or not. IF your state is anything similar to Tennessee, be prepared for the following. 1. Very few Plastic surgeons accept Medicaid (in our state TennCare) because of the extremely low payments and the large numbers of hurdles both patient and surgeons have to jump over. 2. There may be a requirement that you be... more

Coverage for a breast reduction

A plastic surgeon who does breast reductions in your area and is familiar with insurance coverage issues locally should be able to answer this. I would suggest you lose weight first because you will get a much better cosmetic result if you do.