Breast Reduction Q&A
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Does GEHA Cover Breast Reduction?

asked 9 months ago by NYSwagger
Latest answer by Steven Turkeltaub, MD
Question viewed 177 times
Tags: back pain, DD to B cup, insurance, smoking

I'm a 46 yr old 5'0" female weighing 116 lbs. I'm a 36DD and would like to reduce to a 36B. I've experienced all the symptoms; chronic back pain, neck and shoulder pain, bad posture ect. due to my large breasts. I have medical insurance with GEHA and was wondering if they cover the procedure & what their pre-requisites are. Poor body image & high cost have precluded me from seeking medical advice for this issue in the past. Also, I am a pack a day smoker so is this even an option for me?

5 answers to Does GEHA Cover Breast Reduction?

+2

Insurance coverage for breast reduction.

Insurance Coverage for Breast Reduction Article by George J. Beraka, MD Manhattan Plastic Surgeon 80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points. 1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches. 2) Very big reductions (like from an F cup to a... more
George J. Beraka, MD

Manhattan Plastic Surgeon
+2

Breast Reduction and smoking

You can check with your insurance company if they cover breast reductions. An in surance company has certain prerequisites for coverage. They want your height and weight, pictures, and documentation ofr back troubles with results of x-rays and treatment dates. They may also ask for two letters from docors and copies of physical therapy etc. They make it very difficult and try to reject preauthorizations. A patient and their doctor then goes through an appeal process. This takes months. Some... more
Leo Lapuerta, MD

Houston Plastic Surgeon
+1

Question about insurance coverave for breast reduction through GEHA

You need to first determine whether breast reduction is a covered procedure under your insurance policy. If it is, you should schedule a consultation with a board certified plastic surgeon in your area who can do a full assessment and then submit the information to GEHA. Supporting documentation is needed including information that falls within their coverage criteria. Good luck!
Steven Turkeltaub, MD

Scottsdale Plastic Surgeon

www.turkeltaub.com

+1

Does GEHA Cover Breast Reduction?

Best to see in person a boarded PS in your area. He/she can examine, photograph you. Than write a letter vto your insurance company as a predetermination of benefits. The smoking is an issue of concern.
Darryl J. Blinski, MD

Miami Plastic Surgeon
+1

Breast reduction insurance coverage

Every insurance company has different policy and requirements for breast reduction coverage. These requirements seem to be getting more strict as time goes by. You would need to check with your insurance company regarding your specific policy. You should also stop smoking prior to surgery; I asked patients to stop any form of nicotine use one month prior to surgery. I think that you will find that the benefits you will gain from the breast reduction surgery will be worth it... more
Tom J. Pousti, MD

San Diego Plastic Surgeon

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