Will BCBS of Oklahoma Cover Breast Reduction?

Question

I am a 42ddd and they cause me a lot of back pain as well as neck pain that generally causes headaches

Tom J. Pousti, MD · Answer

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; meet with well experienced board certified plastic surgeons for the best advice.

	 The best way to obtain insurance coverage for breast reduction surgery involves some &ldquo;hoops&rdquo; 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 &ldquo;authorization&rdquo; for the procedure. This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.  

	Best wishes.

Steven Wallach, MD · Answer

While each insurance company has different criteria,. and you should check with the company, with very large breasts it would likely be covered.

Kevin Tehrani, MD, FACS · Answer

You should be evaluated by a surgeon certified by the American Board of Plastic Surgery. Your surgeon will then assess your physical condition for the possibility of your symptoms arising due to the size of your breasts. Your insurance company could then be contacted regarding the same if medical necessity is deemed appropriate.

George J. Beraka, MD (retired) · Answer

Hi.  I hope you find this article helpful.  Good luck!

	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.

Will BCBS of Oklahoma Cover Breast Reduction?

Answers (4)

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