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Breast Reduction and Lift Insurance Coverage Requirements?

asked 2 years ago by shannonskinner in Las Vegas
Latest answer by Tom J. Pousti, MD
Question viewed 2,510 times
Tags: age 25-34, breasts, female, 150-169 lbs, 5 ft 0 in to 5 ft 3 in, breast feeding, sagging, C cup, DD cup, F cup, insurance

I am a healthy 28-year-old. I was a 34 DD before having kids. I am 5'3" and weigh 150 lbs. I have 10 more lbs to go before I meet with a surgeon. My breasts used to be firm, perky and although large, very nice. Now they are saggy, huge and limp.

I would like to get a breast lift and breast reduction. I have BCBS of NJ, but live in Las Vegas. I will be done nursing in March. They are now larger than a 36F. Whats the next step? I want to be a 34 large C. I am wearing pink in the photo.

13 answers to Breast Reduction and Lift Insurance Coverage Requirements?

Breast reduction insurance coverage

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 saying a well-trained/experienced... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Insurance coverage for breast reduction.

Answer by George J. Beraka, MDManhattan Plastic Surgeon80% 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... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast Reduction Timing after Breastfeeding and Insurance Coverage

Since you are young, the first question for you to consider prior to undergoing any breast reduction surgery is whether or not you plan to have any more children, and if the answer is yes, do you wish to breastfeed? I recommend to all my young female patients to finish having their children and finish breastfeeding since, as you have experienced, your breasts will grow, change size, change shape, then "deflate" (something we call "involutional hypoplasia") over time.... more

Suzanne M. Quardt, MD
Palm Springs Plastic Surgeon

Insurance Coverage for Breast Reduction

Most insurance companies look at the BSA. This is the body surface area which is a ratio of your weight and height. This is obviously besides your complaints of neck pain, back pain and shoulder grooving. When calculating the BSA you will be give a number like 1.4 or something. This is take and looked at on a sliding scale to determine how much breast tissue needs to be removed per side in grams. If this is the amount to be removed or more then insurance company will likely cover the... more

Farbod Esmailian, MD
Orange County Plastic Surgeon

Insurance usually covers breast reduction as a medically mandated procedure

Breast reduction is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine. Recently, managed care has adopted stricter standards for coverage, so these problems have to be thoroughly documented in writing by your primary care physician and plastic surgeon. They may also have to submit photographs. Even then, you may be required to seek a second opinion from a... more

Michelle Copeland, MD, DMD
New York Plastic Surgeon

Large breast reduction surgeries can usually be covered by insurance

Usually large breast reductions can be covered by insurance, but it is getting tougher. The insurance companies usually want documentation of back, neck and shoulder pain that has been treated by conservative measures but with little to no success.

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance coverge of breast reduction

BCBS tends to use a sliding scale called the Schnur scale to determine eligibility for breast reduction covergae. The ling for this is: http://www.bcbst.com/MPManual/The_Schnur_Sliding_Scale_chart.htm I agree with the other physician's here, that you should allow suffcient time for the post-lactional changes to stabilize.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Breast Reduction and Lift Insurance Coverage

Insurance policies will sometimes cover a Breast reduction but will essentially never cover a lift alone. Coverage depends on symptoms as well as the amount of tissue to be removed. With your cup size at 5'3" and 140 pounds, you probably would qualify assuming that you have pain,etc. (although I have no personal experience with BCBS (NJ). You state that you now wear a 36 bra and would like to be a 34__reductions do not alter this measurement which measures your chest circumference... more

John Whitt, MD
Louisville Plastic Surgeon

Getting insurance to pay for a breast reduction

Hi Shannon - A breast lift is part of a reduction, so this shouldn't be an issue if you get insurance clearance for the reduction. BCBS usually requires 500g of tissue to be removed if you're under 200lbs. Check with your plastic surgeon to see if you're a candidate for this and to make sure that you won't be left with extremely small breasts if 500g is removed.

Jeffrey E. Schreiber, MD
Baltimore Plastic Surgeon

www.BaltimorePlasticSurgery.com

Breast reductions should not be done until 6 months after breast feeding

Hold your horses! Your breasts are still changing. Even though you will only be breast feeding for another 3-4 months, your breasts will continue to change even after March. I wouldn't consider a breast reduction until your breasts have stabilized. You will probably need to wait to see a plastic surgeon until September 2010! To find a good doctor, call your insurance company and then investigate the names of the plastic surgeons on the panel. Make sure that those doctors are truly... more

Michael C. Pickart, MD
Ventura Plastic Surgeon

Wait 3-6 months after stopping breast feeding before Breast Reduction

First you need to wait about 3-6 months after breast feeding cessation before you have your evaluation. During that time contact your insurance carrier to find out specifically what criteria they use to cover breast reduction. You obviously need to have large breasts and symptoms associated with the large breasts. They may require proof of "proper bra support", conservative treatment failure, orthopedic evaluation, physical therapy or chiropractic care. Once you know what they... more

John P. Stratis, MD
Harrisburg Plastic Surgeon

Timing of Breast Feeding and Breast Reduction

As large and droopy as your breasts may be - they are NOT at a stable size as long as you are nursing. To get the best idea of your breast size and avoid reducing a breast which is still large due to the nursing, I would advise you postponing any breast reduction evaluation until you stopped breast feeding for 6 months or so (? September of next year). Assuming your BCBS NJ policy has a Breast Reduction benefit (not all do), every insurance plan has its own requirements for coverage. Many... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Breast reduction by insurance or not

I can clearly understand that you want your reduction to be done under your insurance and you can certainly visit surgeons who can write letters to your insurance seeking preauthorization of coverage. But please also know that these are the only breasts you will ever have and many of the very best plastic surgeons no longer work with any insurance as the reimbursement for a breast reduction to the doctor can be as low as a few hundred dollars depending on the insurance. This doesn't even... more