Might Insurance Cover a Breast Reduction in the Presence of Degenerative Disc Disease?

asked 1 year ago by Mindwhirl
Latest answer by Tom J. Pousti, MD
Question viewed 248 times
Tags: congenital, disc, insurance, spine

I have spondylosis,stenosis,osteophytes & mild rev of lordosis in my cervical spine to which the drs attribute my pain and numbness. I am 29, had no trauma. I am just starting chiro care. An ortho surgeon rec. fusion surgery, but said there is no danger in waiting. I think at least some if not most of the underlying problem is the weight of my breasts. I am 5'3", 150#, 32F with dense tissue. Would a plastic surgeon be able to determine if that is true? Or is this an automatic "no" from ins?

10 answers to Might Insurance Cover a Breast Reduction in the Presence of Degenerative Disc Disease?

Breast Reduction and Insurance Coverage?

Thank you for the question. Based on your description you may be an excellentcandidate for breast reduction surgery.  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, spine doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. This documentation and... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Breast Reduction - Might Insurance Cover a Breast Reduction in the Presence of Degenerative Disc Disease?

Hi Mindwhirl, In your case, it's probably an automatic "Yes." Actually, each insurance company is different and has its own requirements as to what would constitute a covered procedure (you then have to find a plastic surgeon you're comfortable with who either participates in your insurance or would accept it, if you have out-of-network benefits). Your first step should be to contact your insurance company to see which plastic surgeons participate in it. ... more

Alan Engler, MD
New York Plastic Surgeon

Breast reduction is commonly a covered benefit

Breast reduction is a common covered benefit under many insurance policies. However, this varies between insurance companies. The first thing that you need to find out from your carrier is if it is a covered benefit. You can contact them directly. If you would like to come in for a consultation, my insurance coordination staff could do that for you as well. The next thing to know is how much of your breast tissue will need to be reduced. This is based on your breast size, height and weight.... more

Kevin Brenner, MD
Los Angeles Plastic Surgeon

Breast reduction

Insurance can frequently cover breast reduction for symptomatic macro mastic. Documentation of tieback problems are frequently necessary

David L. Abramson, MD
New York Plastic Surgeon

Breast Reduction with Degenerative Disc Disease

With your documented cervical disc disease and the size of your breasts, I think that a breast reduction would probably improve your symptoms but i do not think that your breast hypertrophy is the soe cause of your symptoms. You should probably discuss the potential benefits of breast reduction surgery with your family doctor who can then refer you to a plastic surgeon if he/she feels that you would benefit.

John Whitt, MD
Louisville Plastic Surgeon

Insurance coverage for breast reduction

The criteria for an insurance company to provide coverage for breast reduction vary from company to company and plan to plan. Generally, women who are DDD and larger have enough breast tissue to potentially qualify. First check the exclusions page of your policy - if breast reduction is listed, it is close to impossible to obtain coverage (with very few exceptions). If it is not an exclusion (or if you are willing to fight - usually unsuccessfully), you should see a... more

Craig S. Rock, MD
Houston Plastic Surgeon

www.drcraigrock.com

Might Insurance Cover a Breast Reduction in the Presence of Degenerative Disc Disease?

The only way to determine health insurance coverage is having a boarded pS send a predetermination letter to the insurance companies reviewing panel. A witten response is needed to proceed.

Darryl J. Blinski, MD
Miami Plastic Surgeon

Breast reduction insurance coverage.

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... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast reduction coverage starts with predetermination

Insurance coverage for breast reduction will vary depending on individual plans, many of which have very restrictive criteria for breast reduction no matter how worthy or what symptoms are involved. The process starts with an insurance predetermination letter to your insurance to learn just what your coverage will allow. Best of luck, peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon

Insurance Coverage of Breast Reduction Surgery

Having private health insurance is similar to going to a catered function. Unless you purchased your own policy, just like attending such a (chicken-or-fish) function, you do not have a voice over the menu (or list of covered benefits); it has been ordered and paid for you. If YOUR particular policy has Breast Reduction "benefits", it means either you or your employer paid for such care and therefore, subject to the insurer's requirements, the operation will be covered. On... more