Will Insurance Cover a Breast Reduction?

I am 29 5'2" 120lbs and wear a 32DD. I am considering a breast reduction. Will insurance (united healthcare) cover this?

Doctor Answers (5)

Insurance coverage for breast reduction surgery

+2

Insurance coverage is a fickle thing.  The only way to know for sure is to be evaluated by a plastic surgeon.  At this time a pre-approval letter will be sent.  The insurance company reviews the information and magically make a medical decision whether or not they intend to cover the procedure.  It is not always a fair or just decision.  From your description you seem to be a good candidate for the operation and would get symptomatic relief from your large breasts.


Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

Will insurance cover breast reduction?

+1

Every insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 128 reviews

Breast Reduction Coverage

+1
Breast reduction coverage depends on your insurance plan and whether you meet their criteria.  Call your insurance company and ask for their criteria and whether it is a covered benefit. All the best.

Robert F. Centeno, MD, FACS
Fairfax Plastic Surgeon
5.0 out of 5 stars 39 reviews

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Breast Reduction and Insurance Coverage?

+1

Based on your description you may be a excellent candidate 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, 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 are seeing a well-trained/experienced board-certified plastic surgeons.  Ask to see lots of examples of their work.

When dealing with health insurance companies, be prepared to be persistent.  In the end it will be worth it;  breast reduction surgery tends to be one of the most patient pleasing operations we perform.
 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 793 reviews

Insurance Coverage for Breast Reduction

+1

Your insurance should cover your breast reduction surgery. However, insurance companies have different plans and some exclude breast reduction. Your best bet is to see a Board Certified Plastic Surgeon who specializes in breast reduction, he/she will be familiar with the requirements for authorization. Most companies require that a minimum of 500 grams per breast are needed to be removed, and that is usually a DD cup, they also want documentation of what you have done to alleviate symptoms, such as physical therapy, special bras, analgesics, etc . If you are denied, I recommend that you request an appeal, then it will go to a medical doctor who will consult with your surgeon. I have gotten many cases approved this way. Good luck!

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 35 reviews

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.