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Am I eligible for a breast reduction with insurance?

I am 27 with two kids. I had a tubal, so no more kids. I am 175lbs and I'm 5'1. My breast size is now a 38 G/H. I have went to a chiropractor once, but mainly just deal with the back aches. My shoulders swell, I can't run without them hurting, my bra's are uncomfortable, and I have discoloration under my breast and on my stomach.

Doctor Answers (10)

Am I eligible for a breast reduction with insurance?

+2

Based on your height ,weight ,and breast size,I believe most insurance companies would cover you.If they offer resistance have your surgeon have a conference with their medical director

If your insurance does not cover you,discuss doing your reduction in the surgeons office.The costs are far lower than the hospital. The surgery can be done under twilight anesthesia as an outpatient


Boca Raton Plastic Surgeon
5.0 out of 5 stars 6 reviews

Insurance eligibility?

+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

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 128 reviews

Am I eligible for a breast reduction with insurance?

+1

By most standards you do qualify for insurance coverage.  However, insurance policies are different, as are insurance company guidelines.  You obviously have some degree of obesity as well, but it is totally understandable that with such heavy breasts you are not able to exercise to help lose the excess weight.  This would be a very valid argument with your insurance company in  case they give you the run-around.  Best of Luck.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 12 reviews

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Dr. Kimberly Henry

+1

Hello, and thank you for your questions! Yes it is possible that you can get your insurance company to fund your breast reduction. However, you need to call your insurance company and ask them what they specifically require for you to be a candidate. Best of luck!

Kimberly A. Henry, MD
Greenbrae Plastic Surgeon
5.0 out of 5 stars 4 reviews

Breast reduction for 38G: will insurance cover?

+1

I cannot answer whether insurance will cover you, that is based on your policy and the company. What I can tell you is that having a breast reduction will relieve your pain immediately. Do it today and you will feel better.

Jeffrey Ditesheim, MD, FACS
Charlotte Plastic Surgeon
4.5 out of 5 stars 19 reviews

Breast reduction coverage

+1

Every insurance company is different. Up in NY, we are seeing demands for documented conservative medical management for at least 6 months. That means seeing the chiropractor or physical therapist twice weekly, not once. Of course, as a G/H cup, it should be obvious to all that the only thing which will alleviate your symptoms is a breast reduction but this is a way for insurance carriers to delay and shift the onus onto you. It goes without saying that all those visits carry co-payments which is part of the game. If you can't afford the co-pays, then the insurance company can deny the procedure!

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

Insurance breast reduction

+1

Based on your description, I think you would be. All insurance companies are different, so you would need to check the criteria with your company. It all really comes down to documentation of your symptoms, and a PCP record of neck pain, rashes, etc. helps.

Frederick G. Weniger, MD, FACS
Hilton Head Island Plastic Surgeon
5.0 out of 5 stars 17 reviews

Breast reduction candidate

+1

Most insurance companies will cover breast reduction surgery if you meet the following criteria.

1). A minimum amount of weight has to be removed from each breast and this will vary depending on your insurance company. It is often based on your height and weight.

2) Symptoms of back pain, documented by your primary care doctor for at least 6 months.

3) A trial of conservative therapy which has failed to relieve your back symptoms.

Every insurance company has different requirements, so it is best to get a consultation and then have your doctor check to see if you qualify.

It sounds like you should meet the criteria.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.5 out of 5 stars 21 reviews

Am I eligible for a breast reduction with insurance?

+1

Thank you for the question. Based on your description, you may be an excellent candidate for breast reduction surgery; it is one of the most patient pleasing operations we perform.This operation is best done when you have achieved a long-term stable weight, if you are not there already.

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.

I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 794 reviews

Coverage for a breast reduction

+1

No way to know for sure if you would have insurance coverage for a breast reduction. You should go in for a consultation with a plastic surgeon. Insurance companies use different critera to determine elidgibility fo coverage.

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