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Will my Insurance Cover Breast Reduction in Atlanta?

asked 2 years ago by Jus4u2cee in Atlanta
Latest answer by Tom J. Pousti, MD
Question viewed 1,322 times
Tags: breasts

Prior to moving to Atlanta almost 3 years ago, I had a recommendation from my doctor to seek a breast reduction. Previously, I was on Medicaid in SC but I was instructed to lose weight before approval to receive my reduction. Now, I am a resident of GA and I am still having the same back problems, along with extra breast tissue under my right arm. I've been on my job for over a year and now I'm inquiring if my insurance would approve this reduction. I have Aetna PPO and my breast are 42 DD. Please help?

14 answers to Will my Insurance Cover Breast Reduction in Atlanta?

Breast reduction and Insurance Coverage?

Thank you for the question. Unfortunately, there is no way of knowing whether your procedure will be covered by the insurance company, except for directly contacting them. Your plastic surgeon will be able to contact them on your behalf as well. The more support you have for the “medical necessity” of the procedure the better. Prepare to be persistent. Best wishes.

Tom J. Pousti, MD
San Diego Plastic Surgeon

Insurance coverage for breast reduction

Each insurance company is a bit different and therefore they have different preoperative requirements for approval. Check with yoru insurance company.

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance coverage for breast reduction

Our breast reduction patients are some of our happiest patients. They appreciate their new look and literally have had a significant weight taken off their shoulders. As you know, some insurance policies may cover this procedure. However, it depends on the insurance policy and the insurance company. In our practice, we have seen many insurance companies do everything possible to avoid paying for medically necessary procedures such as a breast reduction. If you are not able to have your... more

B. Pat Pazmino, MD
Miami Plastic Surgeon

Insurance coverage for breast reduction.

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)... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Insurance coverage for Breast Reduction in Atlanta

BAD NEWS - Each insurance company has multiple policies (IE "products) which were paid for by the employers. Some employers buy the the all-options insurance, others save money by leaving out several coverages. Breast reduction MAY be one of them. There is NO WAY of knowing if your policy pays for it or not UNLESS YOU CAREFULLY READ the boring small print insurance booklet that came with your last card renewal. Read it looking for the excluded items. The ONLY way to correctly answer... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Breast Reduction

It really depends on the specific insurance and who is doing the review. It also depends on your height and weight along with the photos and measurements that are submitted. More and more patients are being denied for breast reduction under insurance so it is hard to say that you will be approved. You need to go see a board certified plastic surgeon to go over everything with you and have them submit it to the insurance. You and your plastic surgeon will know before proceeding to surgery... more

Farbod Esmailian, MD
Orange County Plastic Surgeon

Insurance coverage for breast reduction

There are many factors that go in to the process of approval for a breast reduction. It seems that you have the usual set of symptoms that are associated with large breasts. During an evaluation specific measurements can be taken as well as a determination of the amount of breast tissue to be removed. Most insurance companies will give prior approval based upon a ratio of your height and weight compared to the amount of breast tissue to removed. At the time of your evaluation a letter... more

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon

Insurance coverage for breast reduction depends

Breast reductions may be covered by your insurance or maybe not. It depends on a few factors. One: Is the physician in network or out of network? Not all physicians (especially plastic surgeons) participate in insurance plans. If you want to stay in network, (have no payments or limited out of pocket) then you should find out which plastic surgeons participate. Two: Not all health insurance plans cover all surgeries. Some plans exclude breast reduction. Your employer who provides you with... more

Andrew Y. Kleinman, MD
Westchester Plastic Surgeon

Worth trying, but no promises will made from the insurance company

Every inssurance company has special requirements for approving breast reduction. You will require a consultation with a board-certified plastic surgeon. His office will contact the inssurance company on your behalf to get pre-approval for the surgery. As all inssurance companies are very protective of their policies,they consider the pre approval as a a must but not as a guarantee of coverage! It is worth trying anyway. Best of luck!

Hisham Seify, MD, PhD
Los Angeles Plastic Surgeon

Breast reduction coverage by insurance

Every insurance company is different. Some approve reductions by weight removed and some by height and weight. Check with some local plastic surgeons to see if they take your insurance. If they do, see what they can do to get you approved. Also, you may want to consider a University plastic surgeon if nobody in your area takes insurance. Good luck!

Jeffrey E. Schreiber, MD
Baltimore Plastic Surgeon

www.BaltimorePlasticSurgery.com

Insurance coverage for breast reduction

Your best option is to select a plastic surgeon and present for a history and physical examination. The physician can then submit a predetermination of benefits letter with photographs to your insurance company to determine if they will cover the procedure.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Insurance coverage for breast reduction

If you have documented symptoms of back pain, neck pain, shoulder pain, severe grooving from your bra straps, or rashes, your insurance carrier may cover a reduction mammaplasty. You should check with your insurance carrier to ensure that you don't have any exclusion policies for breast reduction and to see if they require a regimen of physical therapy prior to covering the procedure. Most insurance companies require a certain weight of tissue to be removed before they will cover the... more

Sam Jejurikar, MD
Dallas Plastic Surgeon

Check with your insurance company

Each case is different. Best to check with your insurance carrier to see if they even cover breast reductions as many insurers do not. If they do, then find a plastic surgeon who participates with their plan. (there may not be too many choices). After a consultation, the doctor should be able to tell you if the procedure will likely be covered. It mostly depends on your body size and how much the doctor thinks they will remove. If you choose an out of network doctor, then there will be some... more

Dean Fardo, MD
Atlanta Plastic Surgeon

Insurance Coverage of Breast Reduction

Many breast reductions are covered by insurance. Most companies look at your symptoms and your body surface area when deciding. You should obtain a referral from your doctor or search the ASAPS or ASPS websites.