Will Blue Cross Blue Shield Insurance Cover Breast Reduction Surgery if Its Deemed Medically Necessary?

I'm 5 foot 2 in, about to 21 years old and I weigh about 130 or a little less. I went to a chiropractor for about 4 years but all it did was help with my headaches which I've had since the 1st grade. I'm about a 38/40 D and I have severe back/shoulder/neck pain, I have to sleep with a heating pad on my back under my shirt in order for me to sleep cause its the only thing that alleviates the pain to where I'm comfortable. Am I good candidate? I've also tried losing weight but nothing happened.

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age 18-24 D cup 5 ft 0 in to 5 ft 3 in 130-149 lbs back pain Blue Cross/Blue Shield candidate

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6 Doctor Answers | Asked by MargaretS

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Insurance coverage for breast reduction

Is available if your exam confirms that the minimum amount of breast tissue by weight as determined by your height and weight can be removed and still leave you with a size you are happy with. Your surgeon should be able to help guide you through the process and the authorization process could be drawn out if you do not have documentation of the problems/symptoms being refractory to conservative medical management. Good luck with getting the procedure and results that you... more

Curtis Wong, MD

7 reviews

Redding Plastic Surgeon

Breast Reduction and Insurance Coverage?

Thank you for the question. Based on your description, you may be an excellent candidate for breast reduction surgery. It sounds like you have been dealing with breast hypertrophy for several years, along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for your frame causing both physical and psychological distress. As you think about breast reduction surgery make sure you do your homework and... more

You should get insurance coverage for breast reduction.

Hi. I hope this article is useful. 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... more

Insurance for a Breast Reduction?

Most insurance carriers cover breast reduction but always with limits. The biggest limit is how much weight is to be removed from each breast. You will need to see a surgeon to determine that and then the doctor's office will contact your insurance company to see if you meet their guidelines.

You can be sure about breast reduction coverage after predetermination

All Blue Cross plans in Illinois are not alike and the only way to know if reduction is an allowed benefit and under what conditions, is to have the surgeon submit a predetermination request, with a written response in return. We feel you are a good candidate, however insurance coverage has become difficult for many.

Insurance coverage for breats reduction

You are certainly a good surgical candidate. In terms of insurance coverage, check the provisions of your insurance policy. These should be accessible on BC of Illinois' website under breast reduction criteria. Obtain all the chiropractic records, not just a letter and provide them to your plastic surgeon. His office should be able to evaluate the criteria and determine whether you fulfill them. In NY, Blue Cross issued predeterminations but, if memory serves me correctly (I perform a... more