Will Insurance Cover Breast Reduction for D Cup Breasts?

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!

Tags:

breasts D cup pain rash female 5 ft 8 in to 6 ft 0 in athletic B cup insurance

Comment on this

13 Doctor Answers | Asked by Cara210 in Draper, Utah

Doctor Answers (13)
Community Comments (0)

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

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

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

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

12 reviews

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.

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

4 reviews

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

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.

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.

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!