Will Insurance Cover Breast Reduction for D Cup Breasts?
- Asked by Cara210 in Draper, Utah
- 4 years ago
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!
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!
Will Insurance Cover Breast Reduction For D Cup Breasts
Yes, Insurance will cover a breast reduction procedure no matter the patients age if the following criteria are met.
- Amount of Tissue to be removed relative to height and weight (most patients go from a D or DD cup to a C cup)
- History of symptoms caused by condition:
- back problems 2.neck strain 3. bra strap irritation 4. rashes beneath breast
- History of trying to improve symptoms with conservative methods:
- Physical therapy, oral medication, massage etc.
- A letter is then sent for prior authorization by your physician.
Would suggest that you consult with a board certified plastic surgeon and he will be able to give you direction. Also, a link is provided below with more information. Good Luck
Insurance coverage for D cups?
Reductions can be done as early as 15 with parental consent, a proper medical clearance and breast growth that has stopped. Insurance coverage is a hit or miss depending on the carrier. Usually having symptoms related to breast size is necessary for insurance coverage. Getting it covered though is very difficult. Insurance companies wont tell anyone how much tissue needs to be removed to qualify for coverage. Then if the surgeon is 1gram off they deny coverage after the fact. Insurance companies make money by denying coverage. For that reason most plastic surgeon will likely ask for payment up front. Breast reductions are the most gratifying operations because years of neck, back and shoulder pain are gone within days. The final size result depends on your starting size. If you start larger then you will likely end larger. It is not possible to choose a size with any real accuracy. The main reason is that the procedure removes breast tissue but leaves enough tissue to preserve the blood supply to the nipple and areola. Thus more tissue needs to be left behind to ensure nipple viability. The nipple and areola is constantly being accessed during the operation. See a board certified plastic surgeon for specifics on your treatment.
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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 “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.
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) 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.
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 physician first and try to get approval. The process is cumbersome and may still be denied in the end.
The investment for your aesthetic result would be best served by doing this as a cosmetic procedure for yourself leaving the uncaring insurance companies out. Best of Luck
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.
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
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 about getting a breast reduction. The surgeon's office can look at your insurance coverage and see if this is a possibility. It is always helpful to have the policy holder discuss this with the insurance company.
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
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.