Size 40DD Having Issues With Fungus/Yeast Infection - Breast Reduction Needed?

I have infections under my breast often. Would my insurance cover this issue ?

Doctor Answers (14)

Insurance for Breast Reduction.

+2

Yes, this is considered a medical necessity and insurance will cover.  See several doctors for documentation including a dermatologist.  Have good photos taken.  Submit to your insurance.  If denied have your doctor help ou work this out.  You shoiuld get insurance.  Good luck.  


Palo Alto Plastic Surgeon
5.0 out of 5 stars 25 reviews

Insurance coverage for breast reduction

+2

The most common complaints that I hear from patients desiring breast reduction are:

  1. Chronic neck, back and shoulder pain
  2. Poor posture
  3. Bra strap grooving
  4. chronic intertrigo under the breasts

Insurance coverage varies from patient to patient. Some companies require evidence of failed conservative therapy, some require a specific amount of tissue removal based on a patients BMI, some don't cover the procedure at all. A letter from your surgeon to the your insurance company should give you the information you need.

Mark Preston, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 8 reviews

Breast Reduction and Insurance Coverage?

+1

Thank you for the question.

Based on your description you may be a good candidate for breast reduction surgery for physical relief and control of infections.

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. Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.
 

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 681 reviews

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Breast reduction covered by insurance

+1

If you have medical, dermatological problems with your breasts, then your insurance should cover your surgery which will hopefully correct this problems. We usually try and get pre-autrhorization for our patients by taking photos and writing a letter on our patients behalf for each insurance plan is different. Watch my video. 

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 24 reviews

Breast Reduction and Rash

+1

I often see patients in my office who have large breasts and complain of rashes. If you also have back and/or shoulder pain you may be a good candidate for breast reduction surgery. Consult with a board certified plastic surgeon. Upon examination, the surgeon will make a recommendation. If you are a candidate, the office staff should assist you with your insurance company. My breast reduction patients are extremely happy to live a life without pain and rashes. best wishes!

Christine Sullivan, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 18 reviews

Indications for breast reduction surgery

+1

Simply said, size 40DD and yeast infections under breasts are an indication for breast reduction surgery based on a functional need basis and should be covered by your insurance company. Variables which could prevent coverage are  a high Body Mass Index (BMI) and a need for weight loss and lack of any history of previous conservative medical management. Also, coverage varies based on type of insurance coverage. It is best to consult with your family physician for documentation and basic attempts to relieve your symptoms. When visiting a board certified plastic surgeon, photographs should be taken and submitted to your insurance company if indicated or required.

S. Daniel Golshani, MD
Beverly Hills Plastic Surgeon
4.0 out of 5 stars 5 reviews

Breast Reduction and Insurance Coverage

+1

Hi 40DDfungus,

Each insurance company is different and, not surprisingly, it is become harder and harder to get insurance companies to pay for this procedure. In general, though, they will cover the procedure if you can show that removing the indicated amount of tissue (more on that below) will be likely to alleviate certain specific symptoms.

First, then, you have to have those symptoms. Typically they would include neck, back and shoulder pain, bra strap grooving and/or intertrigo (rashes underneath the breasts). The inability to exercise or to sleep comfortably can be additional symptoms.

Then, you have to have "enough" tissue removed. Understandably, if only a small amount of tissue is removed the insurance company is more likely to consider it a cosmetic procedure (called in that case a "breast lift" rather than a breast reduction). It used to be that a breast reduction would be more likely to be "covered" as long as 500 grams - a little over a pound - was removed from each breast. Now, though, it is typically more complicated. In general, you have to remove a certain amount of breast tissue relative to your body mass index. Here's a site that can help you determine your body mass index nhlbisupport.com/bmi/. Even then, though, you will have to find out from your insurance company how much tissue has to removed in order to qualify. Companies don't normally publicize their criteria widely, but they may and, in the meantime, this something that your plastic surgeon may be able to help you with.

So, in your case, I would urge you to collect documentation of the problems you're having, including doctor's notes and photos, and have them submitted along With the request for preauthorization of the surgery.

I hope that this helps, and good luck,

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 146 reviews

Size 40DD Having Issues With Fungus/Yeast Infection - Breast Reduction Needed?

+1

There are a list of insurance criteria for approved breast reduction. Call your insurance company to see if you fit their criteria. I believe you do. Or see a boarded PS in your area to send a predetermination letter to your insurance company with a photo of your breasts. After receiving an approval letter then have the operation. Best from MIAMI 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Insurance coverage for breast reduction

+1

Recurrent rashes under the breasts may qualify your breast reduction for insurance coverage. It is best if you have documentation of seeking medical care for these rashes, such as a doctor's note or a record of prescription medications for the rashes. The strongest criteria for insurance coverage of a breast reduction is a documented history of back pain not responding to other treatments and an operative plan to remove a significant weight of breast tissue per breast (google 'Schnur scale').

Nia Banks, MD, PhD
Washington Plastic Surgeon
4.5 out of 5 stars 16 reviews

Breast reduction insurance coverage.

+1


Insurance Coverage for Breast Reduction
 

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 C cup) will usually be covered.

3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7) Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9) Don't give up. If the first request is denied, demand an appeal.

10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.
 

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 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.