Tips and Chances of Getting Breast Reduction Approved by Insurance?

I am 29 years old, 5'8 and 150lb. I wear a 32-34 G+ and am considering breast reduction. I live in Florida and have Blue Cross Blue Shield insurance. I know that I have to call and make sure that my specific plan does not have a contract exclusion but what are my chances of getting approved for this with BCBS in FL? I have a lot of back and neck pain as well as my shoulders being rolled forward because of the weight and my bra straps dig into my shoulders causing severe pain. Tips? TIA

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5 Doctor Answers | Asked by AJ2517 in Florida

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Insurance approval for breast reduction

Insurance companies generally look at two factors in deciding whether or not to cover a breast reduction surgery: 1. Functional problems. You mentioned several already - back/neck pain and shoulder grooving and pain from bra straps. 2. The amount of tissue to be removed - a breast reduction and a breast lift are essentially the same operation. The only real difference is in the amount of tissue removed. Insurance companies use various charts to... more

Breast reduction in Florida

I can only comment on NY but in any event you should check with your insurance regarding requirements for elgibility because they are getting stricter and stricter.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast Reduction and Insurance Coverage?

Thank you for the question and congratulations on your decision to proceed with 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.  This... more

Getting Breast Surgery Approved by Insurance

Wow, sounds like you have done a great deal of research already. From your question it sounds like you are a candidate for breast reduction surgery. I am a plastic surgeon in San Antonio, Texas not Florida, but the basics are the same. First, I would suggest you call BCBS number on your card and make sure code 19318 is a covered benefit. Then if it is ask for a copy of their coverage determination criteria. Go through the criteria and make sure that you have... more

Breast Reduction Insurance Approval Tips

It sounds like you are aware of some of the insurance criteria, you are on the right track. The office of the surgeon you pick should be able to help you get approval. Be sure you find a Board Certified Plastic Surgeon and look for one who specializes in breast reduction surgery. They will be familiar with the ins and outs of pre-authorization. As you know different policies have different requirements, in general you should have some documentation of what you have already tried, such as... more