I am a 19 year old single mother. I am 5 foot 1, and weigh 113 pounds. My breasts are a 34DD. Since I entered middle school my breasts have been abnormally large for my frame. In 6th grade I was in a C cup. Would Medicaid cover my breast reduction? And if so, how do I go about this process?
Breast Reduction Coverage by Medicaid Possible?
Doctor Answers (9)
Insurance coverage for breast reduction
I am not familiar with Medicaid but I can comment on private insurance. 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.
Breast reduction may be covered by insurance if you meet certain critera, specified by your insurance coverage. Often times, insurance company will need documentation of back pain, shoulder pain, photos, your height and weight, size of your breasts and proposed weight of breast tissue that would be removed. If you do not meet the criteria set by your insurance coverage, you will need to undergo breast reduction by self-pay. Your self-pay breast reduction cost will differ depending on your surgeon's fee, facility fee, and anesthesia fee. There is a geographic difference as well. It will vary from $8000-$10,000. Please visit with board-certified plastic surgeons to discuss the overall cost as well as potential risks, alternatives, and benefits. Good luck to you.
Breast Reduction and Medicaid?
Thank you for the question and picture.
Yes, I think you may be an excellent candidate for breast reduction surgery.
I think the biggest challenge you will have is finding a reputable plastic surgeon who works with Medicaid.
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Each insurance company has different criteria for pre-approval of a breast reduction surgery and you should contact your carrier. Check with Medicaid.
Insurance coverage for breast reduction.
I wrote a long article about insurance coverage for breast reduction for RealSelf. Please read it at the bottom of my RealSelf profile. I think it will help you.
Medicaid Breast Reduction
You will be hard pressed to find a plastic surgeon that accepts medicaid for breast reduction. First it will have to be authorized. Even if approved, the reimbursements are so low that it does not cover the time and the expense of the plastic surgeon, so most would not do it.
Medicaid coverage of breast reduction
First you need to find a plastic surgeon who accepts medicaid and have a consultation. They will help guide you through the precertification process.
Breast reduction under medicaid
I would agree with Dr. Rand's summary.
Breast reduciton may be a covered procedure given your symptoms but the amount of reimbursement is inadequate to cover the vast majoirty of plastic surgeons overhead expenses. Most surgeons cannot run their practices and continue to work based on the payments made by medicaid.
Training programs may be able to provide you with relief from your symptoms and surgery will be performed under the guidance
Breast reduction by Medicaid
Unfortunately, the reimbursement from Medicaid to the doctor for doing a breast reduction is less that the cost to the doctor to do the surgery in most cases so you won't find many practicing plastic surgeons who will take Medicaid.
However, there are some fine training programs in Chicago where plastic surgery residents can evaluate you and probably perform your surgery under the guidance of a professor. Having run one of these programs for 10 years, we did breast reductions on anyone who needed them regardless of coverage.
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.