If one of my breast is extremely larger than the other. Will insurance cover the procedure? One side is probably a very small A and the other is a very full B, almost C. What's your experience with this?
Financing Breast Reduction Through Insurance?
Doctor Answers 23
Unilateral insurance breast reduction depends on insurance coverage and previous treatments tried
Each insurance plan has their own policy about coverage for asymmetry. Your best bet is to start with getting letters of support from your primary and or gyn physician stating the issues you deal with because of your asymmetry (i.e. back/ neck/ breast pain, rashes, grooving of the shoulder(s), inability to fit a bra properly, discomfort with certain activites etc).
I would recommend that you write a letter also telling the insurance company the issues you deal with because of your asymmetry and get additional letters from any practicioners who have treated you (i.e. massage therapist, chiropractor, physical therapist, etc).
Take these letters of support with you to your initial appoitment with your plastic surgeon, and he will submit them along with the documentation he gathers from your visit to the insurance company for approval. He should be able to tell you if you may qualify for a breast reduction with your insurance's requirements (# of grams per breast to be removed is based on your height and weight for insurance approval along with your symptoms and treatments tried before).
Hopefully this information is helpful, best of luck!
Have a question? Ask a doctor
Every insurance company is different
Every insurance company is different. The only similarity is that they all try to deny and delay so they do not have to pay for anything. However, if you have a significant asymmetry, the it is worth pursuing insurance coverage for the procedure. Good Luck.
Functional, reconstructive, and cosmetic plastic surgery
Despite what you may consider severe asymmetry, many insurances no longer cover these procedures.
In the past, insurance companies would pay for reconstructive surgery, and this included congenital deformities or severe asymmetry such as yours.
However, recently they have changed their definition to functional surgery. This is interpreted as meaning that only surgery that improves your function will be covered. In your case, this is not functional surgery and would likely NOT be a covered benefit.
If however, you have a MSA or some other form medical compensation, you may have options available for coverage. If you work for a large corporation, you may want to seek the assistance of your human resource department.
In my own practice, I have been disappointed with coverage for these procedures. I can recall an 18 year old girl whose high school counselor, therapist, and pediatrician wrote supportive letters to the insurance carrier who denied their request for coverage.
You might also like...
No insurance will cover this
Breast asymmetry is not a covered benefit under any insurance. They make a very clear distinction between "functional" vs "cosmetic" issues and this would clearly be cosmetic unfortunately. Also, in terms of insurable breast reductions, you don't sound large enough to apply for coverage because most all insurances require 500 grams (1 pound) of tissue to be removed from each side. At your cup sizes, there isn't this much extra tissue.
Breast Reduction - Insurance Coverage
In general, insurance is more likely to pay for the procedure when there are significant symptoms related to the enlarged breasts (such as neck, back and shoulder pain, bra strap grooving, etc) and less likely to for cosmetic purposes. If the main (or only) issue is that you have asymmetry my experience is that it is relatively more difficult to get this procedure "covered." However, you should speak with your plastic surgeon and have him or her help you on this. From my standpoint this is a correction of a deformity - mild asymmetry is common, dramatic asymmetry is not. Whether or not your insurance company agrees is, however, a separate issue, and one that should be addressed by you with the help of your plastic surgeon.
I hope that this helps, and good luck,
Breast Asymmetry and Insurance Covered?
Thank you for the question.
Unfortunately, it is very unlikely that the insurance companies will provide coverage for your situation ( breast asymmetry). I will suggest that you consult with well experienced board-certified plastic surgeons for more precise advice.
Breast Surgery and Insurance
Unfortunately the type of surgery you would need would not be covered by insurance. You have a couple of options, you could have one side reduced but then you would have very small breasts, or you could get an implant on one side to even out your breasts. But either way, insurance will not cover the surgery as it is not considered medically necessary. In order for a reduction to be covered you would need a minimum of 500 grams of breast tissue per side to be removed, and for most women that would be a double D or more. Even then, insurance companies have different requirements and it is most important to get preauthorization, your plastic surgeons office will know how to help you with this.
Insurace and breast reduction
If you have very large breasts which are causing back pain, your insurance provider may cover your procedure. Usually they are looking for about 500 gms of breast tissue to be removed per side. This varies amongst the different providers so I would check with your plastic surgeon and your insurance carrier. Breast asymmetry typically is not covered unless it is quite severe. Your surgeon needs to document your symptoms and submit photos to the insurance company before they can approve you for surgery.
Please consult with a board certified plastic surgeon and ask your insurance carrier if they will cover all or a portion of your breast surgery.
Insurance will not cover cosmetic asymmetries of the breasts.
It's getting to the point where insurance covers much less of what plastic surgeons do. However, cosmetic asymmetries of the breast have never been paid for by insurance companies (and probably shouldn't be). The procedures are fairly common, outpatient, with little downtime.
The cost of various breast operations is listed on my website.
Breast reduction is covered by insurance when medically necessary
Unfortunately, surgery to correct breast asymmetry is typically not covered. Even though your breasts are different sizes, and I'm sure that bothers you, there is no functional problem. Insurance would not cover your surgery. The only caveat to this would be if you happen to have Poland's Syndrome. In that case, it would be covered. Seek a consultation with a board-certified plastic surgeon, who can help you sort this out.
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.