Breast Reduction Covered by Insurance?

I am 19 years old and have suffered from back and neck pain for 4 years. I am 5'6 and a half and weigh 143 pounds. My breast size is 34G. I have always tried too stay very active but this has slowed me down. The back pain has been so bad i can barely bend my back at sometimes and I am starting to experience numbness and tingling in my fingers and legs. I do not make alot of money but I am on CHP insurance from my mom, so I was wondering about if that could cover the breast reduction.

Doctor Answers (6)

Insurance coverage

+1

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.
Best wishes,

Dr. Basu
Houston, TX


Houston Plastic Surgeon
4.5 out of 5 stars 115 reviews

Breast reduction candidate

+1

Based on your description, it sounds as if you'd be a good candidate for a breast reduction.  Each insurance policy varies, so a call to your carrier can help you to determine if a breast reduction is a covered benefit.  A visit to a Board Certified Plastic Surgeon can help you to learn more about the procedure including risks and benefits. Your surgeon will also be able to assist you with the documentation to show that your condition is medically necessary.  Good luck!

Mennen T. Gallas, MD
Katy Plastic Surgeon
5.0 out of 5 stars 8 reviews

Insurance for Breast Reduction

+1

It sounds like you meet the criteria for breast reduction surgery. Contact your insurance company and see if it is a covered procedure under your policy. Some companies have it excluded no matter what your symptoms are. If it is a covered procedure, see a Board Certified Plastic Surgeon for a consultation. Your surgeons office will be able to submit to your insurance on your behalf to obtain pre-authorization. If the insurance company denies it, ask the office to file an appeal for you, many times the insurance company will reverse their decision. Good luck!

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 29 reviews

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Insurance Coverage for Breast Reduction

+1

If your primary care physician provides documentation and treatment of your symptoms arising from you breast hypertrophy, you should be able to have insurance pay for breast reduction surgery. Your growth in both stature and breast size should be stable. You could then be evaluated by a plastic surgeon for surgical treatment. Your surgeon will go over the pros and cons of having breast reduction surgery at a young age.

Reducing the size and weight of the breasts will make a huge difference in your back and arm pain. Exercise will become easier and much more enjoyable!
Thanks for your question. Best wishes!

 

Gregory C. Park, M.D.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 51 reviews

Breast Reduction and Insurance Coverage?

+1

Thank you for the question.

Based on your description you may be a good candidate for breast reduction surgery.
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.

Be persistent when dealing with health insurance companies;  keep in mind, that breast reduction surgery tends to be one of the most patient pleasing operations we perform.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 702 reviews

Insurance coverage of breast reduction.

+1

By your description, you sound like a very good candidate for breast reduction surgery. With documentation of your physical problems it should be covered by insurance, unless your policy has specific clauses that exclude this. The best way is to review your insurance policy and then consult with a board certified/eligible plastic surgeon. Good luck as this procedure will change your life.

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 7 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.