How to Qualify for Medicaid for Breast Reduction?

asked 2 years ago by phenom69 in Pine Bluff, Arkansas
Latest answer by Tom J. Pousti, MD
Question viewed 5,496 times
Tags: breasts, after pregnancy, insurance, pain

Ok I just had a baby, and my medicaid ran out. They say its very hard to get it back once it runs out because its hard to prove you have a condition. Is there any way I can get Medicaid easier? How do I prove I'm having these neck and back pains? How do I qualify for the procedure?

Can I get a Breast Reduction and they still look perky and full? Do you think it's time for a Breast Reduction?

9 answers to How to Qualify for Medicaid for Breast Reduction?

Breast reduction by medicaid

Probably most plastic surgeons in private practice wouldn't take medicaid because the reimbursement won't even cover their costs to do the reduction. I would go to the regional university hospital where the plastic surgeons will take care of you regardless of coverage.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Breast Reduction and Medicaid?

Thank you for the question and picture. Yes, I think you are an excellent candidate for breast reduction surgery. I think the biggest challenge you will have is finding a reputable plastic surgeon who works with Medicaid. Best wishes.

Tom J. Pousti, MD
San Diego Plastic Surgeon

Insurance coverage for a breast reduction

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

Steven Wallach, MD
Manhattan Plastic Surgeon

Financing 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 lift or 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

Qualifying for Medicaid for Breast Reduction

I must agree with the previous expert posters. First, get a Medicaid coverage / card. Then TRY and find a boarded Plastic surgeon and hospital that accepts Medicaid. If you cannot, then by all means go to a local university hospital to the division of Plastic Surgery for this operation. Best of Luck.

Darryl J. Blinski, MD
Miami Plastic Surgeon

Medicaid Coverage of Breast Reduction

Perky and full is not a realistic outcome following breast reduction in your particular instance. As Dr. Rand has discussed, it is highly unlikely that most plastic surgeons in private practice would be willing to accept Medicaid. However, seeking care at a University Hospital is more reasonable option.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Medicaid Breast Reduction

First you need to get Medicaid coverage. You should already know how to do that. I'm not sure why you are not still covered. Next you need to see you family Dr and discuss any symptoms you might have. They will treat those symptoms or refer you to a plastic surgeon. If you are not having symptoms and just want smaller lifted breasts that is cosmetic and not covered by insurance. Once in the hands of a plastic surgeon they will guide the process

John P. Stratis, MD
Harrisburg Plastic Surgeon

Medicaid coverage of Breast Reduction

From your photo, it certainly appears that you would benefit from a breast reduction. The criteria for both your participation in the program as well as the coverage of the operation varies among states. Another likely problem will be finding a plastic surgeon willing to perform the procedure if it is covered by Medicaid because of their typically very low reimbursement rates. If you live near a medical school, you might check to see if someone there could evaluate you.