Breast Reduction Surgery-How to Get It Covered?

I am 5'2 and 130 pounds. My size right now is 36DD. I am looking to have a reduction due to aches in my lower back and neck area, but don't want to lose all of my breasts. How much would be required to be removed in order for my insurance to cover it?

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6 Doctor Answers | Asked by lpridgen

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How to get Insurance Coverage for Breast Reduction

Getting Insurance Coverage for Breast Reduction Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company. In your case: The more Physician recommendations for breast reduction the better - that would include your gynecologist, primary care doctor, plastic surgeon, chiropractor, etc.They want to see that you have already tried non surgical means such as weight loss, physical therapy, chiropractic treatments, etc but still have problems.... more

How to get approved for breast reduction surgery

First of all, give your carrier a call and save yourself a lot of grief. Inquire specifically based on your dimensions how many grams would have to be removed. A DD is not very large, so your fear of having most of your breast removed, may be well founded. I understand cost can be a major limiting factor, but why would you let an insurance company dictate your breast size? Consider funding it yourself so that YOU will decide what size is best for YOU. Breast size is not scientifically... more

Breast Reduction and Insurance Coverage

Each insurance company and plan has different requirements regarding coverage of breast reduction. Documentation and independent verification from your primary care physician, physical therapist, and/or chiropractor will help your case with the insurance company. Consult with 3 - 4 experienced and expert board certified plastic surgeons to understand your options.

Breast Reduction and Insurance Coverage?

Based on your description you may be a good candidate for breast reduction surgery; It 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. You will find that... more

Breast reduction and insurance

As for your specific situation it is always best to go for an evaluation first. Without an exam, it is impossible to say what volume could be reasonably removed to leave you a nice shape and volume.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast reduction coverage

Every insurer uses different standards so it is advisable to check on the carrier`s website. A board certified plastic surgeon who performs a lot of breast reductions should be knowledgeable, although the rules of the game are constantly changing. Many insurers require documented conservative medical management; in NY, they run the gamut of between 3 months to a full year of treatment.