Will Blue Cross / Blue Shield Cover a Breast Reduction?

i'm 5'3 and weigh 170 lbs. my breast size is an E.

Doctor Answers (7)

Insurance coverage for breast reduction - los angeles

+2

Hello and thank you for the question.

Your insurance carrier may indeed cover your breast reduction surgery. You will need to go to your plastic surgeon's office and obtain a pre-authorization for the procedure. Your physician will typically need to write a letter of necessity to the carrier along with providing photographs. They will then provide a response, delineating the amount of coverage, if any, for the procedure.

Best of luck,

Glenn Vallecillos, M.D., F.A.C.S.


Beverly Hills Plastic Surgeon
5.0 out of 5 stars 20 reviews

Insurance coverage for breast reduction surgery

+1

Insurance coverage is a fickle thing.  The only way to know for sure is to be evaluated by a plastic surgeon.  At this time a pre-approval letter will be sent.  The insurance company reviews the information and magically make a medical decision whether or not they intend to cover the procedure.  It is not always a fair or just decision.  From your description you seem to be a good candidate for the operation and would get symptomatic relief from your large breasts.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast Reduction and Insurance Coverage?

+1

Thank you for the question.

Based on your description you may be an excellent candidate for breast reduction surgery; it is one of the most patient pleasing operations we perform  and an operation that is sometimes covered by health insurance companies.

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  working with a well-trained/experienced board-certified plastic surgeon.

Best wishes.
 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 751 reviews

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Breast Reduction - Will Blue Cross / Blue Shield Cover a Breast Reduction?

+1

Hi mstj,

Probably, but no way to say for sure without knowing more, and without going through the whole process.

There are many issues with respect to insurance (you can always pay for the surgery on your own, but that may not be necessary.  Or desirable!).  Each insurance company is different, and each has its own rules with respect to "coverage."  You'll first have to contact your company to make sure it's covered, and then you have to find a surgeon who will accept the payment the insurance company says is "usual and customary."  That may or may not be easy to do.  If you start with the surgeons who participate in the insurance company you'll be off to a good start.  If you'd rather use a different surgeon, and you have out-of-network benefits, you can contact the surgeon's office and see if he/she will accept that payment.

Either way, you'll need the help of a plastic surgeon to submit a letter of precertification and photos and to make sure that everything is set before you have the surgery.  You should, of course, meet with a few plastic surgeons to see what they recommend, and make sure you're informed about the procedure and its risks so that you can proceed knowledgeably.  If you do all of this you'll be most likely to have a result you'll be happy and comfortable with.

Based on your height, weight and bra size, my guess is that there's a good chance it will be "covered," though they may ask you to lose weight and/or try conservative therapy before making a determination.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 151 reviews

Breast reduction

+1
The type of blue cross will depend on the requirements for getting insurance coverage for breast reduction. You will have to check with you plan

David L. Abramson, MD
New York Plastic Surgeon
3.0 out of 5 stars 4 reviews

Breast reduction and insurance coverage

+1

Given your height and weight and E cup breast size I believe your insurer will probably cover the breast reduction.   Your surgeon will have to obtain preauthorization from Blue Cross or Blue Shield.  The authorization process may take a few weeks and the insurer will probably request preoperative photos of your breast to determine eligibility.  In my office, we work with insurance companies on a regular basis to get  this procedure covered and we are usually successful in getting the surgery approved.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
5.0 out of 5 stars 17 reviews

Blue Cross/Blue Shield covering a breast reduction

+1

It is very possible that your insurance may cover your surgery. What you can do on your own is contact your insurance and ask if it is a covered procedure. BC/BS has many different types of policies, some have exclusions and some don't. If you find out that it is a covered procedure for your policy, you then need to have a consultation with a Board Certified Plastic Surgeon. Your surgeons office should be able to help you go through the steps to get pre-authorization for your surgery. Different insurance companies have different requirements, such as how much breast tissue is to be removed, what other steps you have taken to alleviate your condition, i.e. good support bras, physical therapy, medication etc. Good luck!

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 30 reviews

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.