I'm looking into having a breast reduction some time in 2012. I've had very large breasts since I was a teenager and they are not correctly portioned to my body size. I'm a large D cup with a small frame at only 5'3" and weigh 125 pounds. I called my insurance last week to see if this was a covered procedure, and they told me it is covered under my plan, but my doctor would have to submit that it is medically necessary. Do you think based on this info I have a good chance of getting approved?
Breast Reduction from Large D to B?
Doctor Answers (6)
Breast Reduction Candidate?
Thank you for the question. Congratulations on your decision to look into breast reduction surgery; it is one of the most patient pleasing operations would perform.
Based on your description you may be a good candidate for breast reduction surgery; for physical and emotional reasons.
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.
Before undergoing the breast reduction procedure it is very important to communicate your size goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
Make sure you seek consultation with well experienced board-certified plastic surgeons.
Insurance does pay for breast reduction if is is a covered benefit and you meet the requirements
Yes, your plastic surgeon can submit documentation to your insurance company for precertification and predetermination based on your symptoms of neck, back, and shoulder pain. A determination can be made before the surgery to see if your insurance companies agrees to pay for breast reduction for you. Good luck.
Will insurance cover my breast reduction?
The short answer is most likely. At my practice we have nearly a 100% success rate in getting breast reduction surgeries covered as long as it is a covered benefit by your insurance carrier. Since you are a small person with large breasts your case must be evaluated using your height and weight. Taking 500g of breast tissue may be too much and using a formula adapted from the schnur scale your plastic surgeon can give you an idea of how much breast tissue will need to be removed for insurance coverage. In small women I've gotten approval for 275g or more rather than the standard 500+g that is often quoted. You need to start with a consultation and remember that insurance companies tend to drag their feet before saying yes. Hope that helps. Dr. Kerr
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Breast Reduction is often covered by insurance
Because breast reduction surgery relieves symptoms of back pain, neck pain, breast pain and other medical problems associated with having large breasts, it is considered a reconstructive surgery and is often covered by insurance.
In most cases insurance carriers will reimburse the majority of the cost of the procedure as long as a certain amount of breast tissue is removed (on average, at least 500cc of breast tissue from each breast) and the necessity to relieve medical symptoms is well documented.
From the information you've provided, it sounds like you'd be a great candidate for this procedure. Be sure to discuss all of your goals and concerns, including insurance coverage, with a board certified plastic surgeon.
Breast reduction candidate
It is best to go for a consultation to see if you are a candidate. The doctor examining you can go over your symptoms and give an estimate of the weight to be removed during surgery.
Breast Reduction Surgery
Thank you for your question. Breast reduction surgery is a common procedure performed among plastic surgeons. And it is a procedure that has a very high patient satisfaction rate. Individuals interested in having a breast reduction should seek a consultation with a board certified plastic surgeon and discuss your options. As for coverage with you insurance it depends on your individual insurance plan. And the insurance company requires documentation that demonstrates medical necessity.
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.