Would I Qualify for a Breast Reduction?

Hi my names Bobbi I'm 24 years old 5"1 and my breast size is 36dd. My husband was looking into this on a show. I've always had back problems, been the same size for 2 plus years. I have blue cross blue shield right now. Thought about looking into and getting looked at to see if I qualify for reduction. And help would be appreciated.

Doctor Answers (8)

Breast reduction criteria

+1

Breast reductions are authorized by insurance companies if 2 criteria are met.  First, you must have symptoms generated by enlarge breasts such as neck, back or shoulder pain or rashes.  Second, you must have an amount removed that meets their criteria.  At size 36 DD each 200 grams would be 1 cup size change.  They detemine the amount removed based on your body surface area, computed from your height and weight.  My guess is that they will probably require 500 grams removal, which would put you about a size C.  You may not be happy with that because it may not be proportionate to your body size.  Your other alternative is pay for it yourself and you get the size you want without excessive removal.  There is a new technique called The Ultimate Breast Reduction, which transfers the weight of your breasts to the underlying muscle.  This is done without any vertical scars so you don't have the ugly boat anchor shaped incisions and pain relief is immediate.

Best Wishes,

Gary Horndeski, M.D.


Texas Plastic Surgeon
5.0 out of 5 stars 134 reviews

Insurance coverage for breast reductions

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You are describing a clinical set of symptoms that suggests you may be a candidate for breast reduction. More and more insurance companies are listing this procedure on their exclusion page which doesnt offer coverage unless certain criteria are met. Ask your insurance company about this first and then talk to a plastic surgeon. 

Nick Masri, MD
Miami Plastic Surgeon
4.5 out of 5 stars 10 reviews

Hello

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The best person to answer this question would be your primary care doctor. Going over your symptoms with your doctor so they can send information to your insurance for authorization.

Stuart B. Kincaid, MD, FACS
San Diego Plastic Surgeon
4.5 out of 5 stars 8 reviews

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Breast Reduction Candidate?

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Thank you for the question.

Based on your description you may be a good candidate for breast reduction surgery; This operation is one of the most patient pleasing operations we perform.


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 are  consulting with  well-trained/experienced board-certified plastic surgeons.  

Also, be prepared to be persistent when dealing with health insurance companies.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 789 reviews

Breast reduction and insurance

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First, it is always best to ask your insurance company for the criteria that they use to determine eligibility.  Some may want 6 months of notes from treating physicians for your symptoms( i.e. chiropractor, ortho, derm, internist)  It is always a good idea to see a plastic surgeon to see if you are a candidate. It sounds like you are from your description.  Good luck.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Breast reduction criteria

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Take a look online to see your insurance criteria. This will tell you whether you may qualify. Insurers make a big deal about body mass index and you haven't provided a weight. Conservative management of back pain us also important to establish medical necessity.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 13 reviews

Breast Reduction sounds reasonable

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Bobbi, you sound like you would benefit from a breast reduction.  You will need to meet the criteria that your insurance companies has for this procedure.  Sometimes the criteria are pretty hard to meet.  I always recommend that patients call the insurance company and ask to see the list of criteria that is required for a breast reduction from that company.  The next step is to get a consultation from a board certified plastic surgeon and the practice will know how to obtain the preauthorization.  If you do your part from the consumer side and the practice does its part then you have a better chance of success.

Best Wishes

Dr. Peterson

Marcus L. Peterson, MD
Saint George Plastic Surgeon
4.5 out of 5 stars 18 reviews

Qualification For Breast Reduction

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It sounds as if you are a good candidate for a breast reduction with your DD cup size and back pain.  You should get a consultation with a board-certified plastic surgeon with whom you can discuss the procedure.  Afterwards he/she can communicate with your insurance company.

John Whitt, MD
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

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.