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Will Insurance Cover Breast Reduction for D Cup Breasts?

asked 2 years ago by Cara210 in Draper, Utah
Latest answer by Tom J. Pousti, MD
Question viewed 1,548 times
Tags: breasts, female, 5 ft 8 in to 6 ft 0 in, athletic, B cup, D cup, insurance, pain, rash

I'm 5'9" with size 32D breasts. I am very athletic and small framed. I would love to get rid of back, neck, and shoulder pain as well as rashes, through a reduction to a small 32B. Am I a good candidate for the procedure?

What advice, if any, do you have for me? Thank you so much for any input!

13 answers to Will Insurance Cover Breast Reduction for D Cup Breasts?

Breast Reduction and Insurance Coverage?

Thank you for the question. Based on your description, you may be an excellent candidate for the breast reduction procedure; 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... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Insurance coverage for breast lift or 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)... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast Reduction and Insurance coverage

Although insurance should give you the benefits you deserve, the results that you may need are best served with a plastic surgeon who performs the surgery commonly, than by a insurance network physicians. Many patients have tried to get their procedure covered but are met with fairly unintelligent blocking mechanisms like weight criteria and gram removal. Most of these delineations don't really help the individual who is trying to get covered and so you will be best inclined to chose a... more

Khalique S. Zahir, MD
Mclean Plastic Surgeon

Insurance coverage and breast reduction

While you may be an excellent candidate for breast reduction, each insurance company has different criterias for approval. You should check with your insurance company. Many want documented histories of the symptoms you describe with treatment that has not alleviated the symptoms with conservative management.

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance coverage for breast reduction

The insurance companies don't tend to cover for cup reduction, but rather weight reduction of the breasts. Typically, they require about 500 gms (about a pound) per side. You may or may not qualify but it is worth a try. Also, it may be worth paying a visit to your HR or insurance agent to see what your poliy requirements are.

Scott E. Kasden, MD
Dallas Plastic Surgeon

Breast reduction insurance is meant to improve symptoms

Dear Cara, You have the symptoms of large breasts and it sounds like you would be a good candidate for the procedure. A lot of people ask their insurance company to provide coverage for the procedure. Some insurance companies may include this and others don't. Even those companies that provide coverage have some pretty big restrictions. Of course you can have a breast reduction with a self pay situation. Get a consultation with a board certified plastic surgeon and he or she can tell you... more

Marcus L. Peterson, MD
Saint George Plastic Surgeon

Insurance coverage for breast reduction

In my state (New York) and in many others, the criteria for breast reduction insurance coverage are: 1. Excision of at least 500 Grams./side 2 .Proof of prior failed treatment for back and neck pain by physiotherapy or chiropractic or chronic use of pain medication. 3.Chronic inflamation of skin under breasts which has not responded to local care 4. Photos

Barry H. Dolich, MD
Bronx Plastic Surgeon

Breast reduction coverage

You should check your policy to see if reduction is even on it as a covered benefit and if it is, how much weight is needed to remove for coverage. Most of the time 500 grams per side is required (one pound) so at a D cup. you porbably don't qualify for coverage. That doesn't mean you shouldn't do one, it just means it won't be covered by insurance.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Insurance coverage for breast reduction

Every insurance company has their own criteria and you should contact your insurer to fiond out what they cover and what their criteria are. Thereafter you will probably need to see you family Dr so he can document the problem and either start non-surgical treatment or refer you to the proper physician.

John P. Stratis, MD
Harrisburg Plastic Surgeon

Breast Reduction Coverage

Whether or not an insurance company will cover a breast reduction is always difficult to answer, especially without an examination. The criteria vary a good deal among insurance companies. If your insurance co. uses the usual table to determine coverage, there is at least a chance that they will provide coverage. The only way to know for sure is to have a consultation with a Board-certified plastic surgeon and have him/her communicate with the ins. co. Good Luck!

John Whitt, MD
Louisville Plastic Surgeon

Insurance should cover Breast Reduction of D cup breasts

Most likely insurance SHOULD cover Breast reductions. Go see a board certified plastic surgeon who can determine if you are a good candidate, research your insurance, send a letter to your insurance to verify coverages. This can take 2 months to obtain so be patient. Good Luck! PS: Just did an insurance covered surgery. It took 3 months to receive coverage ok's.

Darryl J. Blinski, MD
Miami Plastic Surgeon

Insurance coverage of Breast Reduction

Although, logically speaking, cases such yours should probably be covered by insurers, the best answer you could get from this forum is a decided - Maybe. First, you need to make sure your policy even has "Breast reduction Benefits". Many policies are written without them (to make them cheaper) and you may have such a policy. If your policy DOES have Breast Reduction benefits, look up the names of the plastic surgeons who take your policy. Check them against the list of Plastic... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Insurance coverage for a breast reduction

It is very likely that your procedure would be covered but to be sure it is best for you to seek evaluation and examination by a surgeon who can then prepare a letter of predetermination of benefits to your insurance carrier.