BSBC of Texas Cover my Breast Reduction?

I have BSBC of Texas the PPO plan and I was wondering if the insurance would help pay for a breast reduction. I am 21 years old I am about 5'0 weight about 140 lbs. I work out and I believe I am in good shape but my breasts are uneven they are a 38DD, I have frequent headaches, my neck is curving, I have shoulder indentions, I have bad posture, and when I got a physical they told me my back was curving wrong!! my mother had a breast reduction and also was a DD. She had 4000 grams taken out.

Doctor Answers (9)

BCBS coverage

+1

Every insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX


Houston Plastic Surgeon
4.5 out of 5 stars 128 reviews

Insurance coverage for breast reduction

+1

Thank you for your question.  Based on the symptoms and physical findings you have described, I think you would be a good candidate for a breast reduction.  Many insurance companies will cover a breast reduction but often make it difficult and try to deny coverage by saying it is a cosmetic operation.  You will need to check your explanation of benefits from your insurance company to see if this is a covered procedure.  If so, consult with a board certified plastic surgeon to discuss your options.  Typically a pre-certification/pre-determination letter will be necessary from your surgeon.  This will document your symptoms and physical findings as well as past treatments.    Once received, your insurance company can approve or deny coverage or ask for more information and documentation.  This process can take 1-2 months.   Good luck!

Matthew H. Steele, MD
Fort Worth Plastic Surgeon
5.0 out of 5 stars 46 reviews

Insurance coverage for a breast reduction

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Based on your description of your size and your physical problems, you sound like an excellent candidate for a breast reduction.  Review your policy coverage or contact your benefits administrator to find out if breast reductions are covered by your insurance plan.  If they are, find a board-certified plastic surgeon and have a consultation.  Your case can then be submitted for approval by your insurance plan.  Good luck!

Naveen Setty, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 27 reviews

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Breast insurance for breast reduction

+1

Based on your description, you have good chance of insurance covering breast reduction.  You should consult with a plastic surgeon who can initiate the preauthorization process for you and determine if you meet the insurance company's criteria.  

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 12 reviews

Candidate for a breast reduction and insurance coverage

+1

Most PPOs will cover a medically necessary breast reduction.  The first step is to be evaluated by a plastic surgeon in your area.  From your description you would seem to be a good candidate for the procedure

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

It Depends

+1

Dear Sanissya, I would love to give you a simple answer of yes but I can't. Some insurance policies do NOT cover breast reduction, plain and simple, and it is spelled out in the contract. Others require pre-authorization and it is dependent upon a formula called the Schnur Scale. This calculates body surface area based on your height and weight and then gives you an amount in grams that needs to be resected (removed) for insurance to consider covering it. Most plastic surgeons will be happy to see you in consultation to discuss your options and proceed with the process on your behalf. Look for a board certified plastic surgeon who has done a good number and can show you pictures. Good luck, Dr. Schuster in Boca Raton

Steven Schuster, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 reviews

PPO Coverage for Breast Reduction

+1

     PPOs usually cover breast reductions, but many have specific amounts of breast tissue that must be removed.  Your plastic surgeon will be able to advise whether or not the amount removed meets your expectations.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 237 reviews

Breast Reduction and Insurance

+1

Each insurance company has different policies,  within one insurance company one policy may cover and another may not. You can contact your insurance company directly and ask if yours is a covered procedure  and/or have your plastic surgeons office check for you. If they do cover it, they will have certain requirements and again your surgeons office should be able to help you get pre- authorization. It is getting more difficult to get approval these days, if you get denied, ask for an appeal, many times that will work. Good luck.

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 35 reviews

Insurance coverage for breast reduction

+1

It is impossible to say for sure on line.  However, here is how you go about getting a real answer.

 

First since there are so many policies go to your HR person, or whomever knows YOUR coverage.  Some plans exclude it completely.  Find out what the requirements are.

 

Armed with this information, you go to a plastic surgeon and see if you would qualify.  Based on your description, you would be greatly helped with a reduction.

 

sek

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 51 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.