Will Insurance Cover Breast Reduction of EE and DDD Breasts?

I'm 28 and I have Medicaid but I was wondering if a Breast reduction would be covered. I have one breast that measures as an EE and the other as a DDD and it looks very weird in clothing I'm stuffing one side of my bra and I have deep grooves in the shoulders with horrible back pain.

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age 25-34 back breasts shoulder DDD cup E cup pain female insurance

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12 Doctor Answers | Asked by maraboo21 in NJ

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Breast reduction

Insurance, medicare, and medicaid usually pay for reductions of this size. When you go for your initial consultation your surgeon should be able to answer the question with more assuredness.

Will Insurance Cover Breast Reduction of EE and DDD Breasts

Insurance carriers vary on what type of surgeries they will cover. Some insurance companies have a written exclusion for breast reductions and it becomes more difficult each year to have these procedures approved. When an insurance carrier does cover breast reductions there are certain criteria such as symptoms of neck and back pain, grooving of the shoulders and intertriginous rashes. The surgeon must evaluate and determine how much breast tissue will be removed and see if this... more

Insurance Coverage for Breast Reduction

Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company but from your photos and description I believe that Medicaid will cover this procedure for you. Contact Medicaid and request their specific Criteria. Here is some general information however to help you :Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive... more

Large Breasts, Bra Furrows, and Neck Pain

Based on the information in your question with large breasts, bra furrows and neck pain, breast reduction surgery is very well may be covered by Medicaid depending on the local carrier. My advice is for you to see a plastic surgeon and be evaluated. Photographs and all of the necessary documentation can then be sent to your insurance company for authorization.

Insurance coverage for reduction of EE breasts

Some Medicaid intermediaries will cover breast reduction. Generally, the larger the breasts, the more likely insurance carriers will be to pay for the surgery. Their requirements for conservative medical management are waived in cases which require removal of over 1000 grams of tissue per breast. I do not recommend that you call the insurer to inquire because the personnel who respond to patient calls are not in the medical management department and regularly provide misleading... more

Breast reduction insurance coverage

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 saying a well-trained/experienced... more

Insurance coverage for EE and DDD breasts.

Thank you for including a photo. You do indeed have large breasts that would be appropriate for reduction mammoplasty, and you would likely be extremely happy with the results after properly-performed reduction (which also lifts the nipple position and improves symmetry between breasts! However, large breasts are often associated with large women, and that is why many, if not most, insurance providers (including Medicare, Medicaid, and state insurers such as MinnCare here in Minnesota)... more

Breast size and BMI both important

The breasts are attached to the body--so your question can't be answered without knowing more. The importance of BMI is partly strategic (how much the surgeon will remove) and partly patient safely (complications are higher in patients with BMI's over 30). Once you are below 30, you certainly are a candidate and will get great relief from your symptoms. Get good advice from a plastic surgeon whom you trust.

Breast reduction insurance coverage varies

Each individual insurance company has different criteria for coverage of breast reduction surgery. The easiest way for you to get a straight answer regarding your coverage is to call your insurance company and find out what they need to make a decision for approval.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast reduction and insurance coverage

Each insurance company and each plan will have their own criteria for covering breast reduction surgery. It usually depends on your symptoms and the amount of tissue removed at the time of surgery. Most will want you to have tried conservative measures such as seeing a chiropractor before getting approval for the surgery. From your photo you appear to qualify by most standards. I would recommended finding a board certified plastic surgeon that accepts your insurance and getting consultation... more

Medicaid Coverage of Breast Reduction

It certainly appears from your photo that most insurance companies would cover your reduction. However, each state determines what is and is not covered under Medicaid. You should obtain a consultation with a Board-certified Plastic Surgeon in NJ who accepts Medicaid.

Insurance and breast reduction

In the photo you provide, you appear to be a good candidate for breast reduction but we cannot predict what your given insurance will cover. The best place to start is to have good documentation through your primary care provider for conservative means that you have tried to deal with the issues that bother you (shoulder grooving, rashes, etc.). Then I would suggest you meet with a plastic surgeon who works with your carrier and have them examine you and make a determination about what... more