Breast Reduction Medicare Coverage and Previous Surgery Pain

I am a size DD, and have had surgery on my cervical spine. I'm still having pain, I have Medicare; will it pay for a breast reduction?

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6 Doctor Answers | Asked by dntlinton in South Carolina

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Breast Reduction and Insurance Coverage?

Thank you for the question. 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 justifying the “medical necessity” of the operation... more

Insurance coverage for a breast reduction

You should first check with your insurance carrrier to determine what their cirteria are. Then see a plastic surgeon. You may also need notes from a treting physician for back pain and neck pain.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Insurance coverage for breast reduction

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

Medicare payments for Breast Reduction

I agree with Dr. Placik. One of the frustrations with the IMMENSE bureaucracy of Medicare is that they will not tell the surgeon BEFORE surgery if they will or will not pay for a Breast reduction. In addition, although their fees for this procedure vary based on where you live, uniformly their fees are quite unreasonably low. The prospect of not being paid and the certainty of being paid poorly for the operation makes it very hard for Plastic surgeons who must pay for their overheads to... more

Breast reduction coverage with Medicare

The problem with medicare is that you cannot send a photograph or obtain any degree of predetermination of benefits prior to surgery which can be typically compl,eted with other insurance carriers. You can find a Medicare participating physician and discuss with them.

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Medicare Breast Reduction

Coverage of breast reductions by Medicare gets a little "tricky". Medicare will not give prior approval for breast reduction or any other surgery, whereas most insurance companies will give you this answer. The criteria vary from state to state even though Medicare is a federal program. You should have a consultation with a BC plastic surgeon who can give you an opinion on whether or not your surgery would be covered.