19 yr-old, 5'4", 125 lbs, 32G considering breast reduction. Will it be covered by insurance?
Doctor Answers 3
Breast Reduction and Insurance Coverage?
I'm sorry to hear about the problems your breasts have caused, starting at an early age. Based on your description you may be an excelent candidate for breast reduction surgery.
Unfortunately, online consultants will not be able to definitively state whether any specific “insurance” will cover your procedure. You will need to consult with board-certified plastic surgeons in your area and check with your insurance company regarding your specific policy.
Undoubtably there will be some 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.
Good luck with your goals; breast reduction surgery tends to be one of the most patient pleasing operations we perform.
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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.