Breast Reduction Q&A

95%

WORTH IT RATING

456 Reviews

Ask a Question

View Before and Afters

Average Breast Reduction Cost: $4,725

Learn about Breast Reduction

1,815 people and 561 doctors are talking about Breast Reduction

Get Free Email Updates

How Does Insurance Coverage Cover Breast Reduction Surgery?

asked 1 year ago by Sarah101 in Florence, AL
Latest answer by Tom J. Pousti, MD
Question viewed 1,092 times
Tags: age 17 or under, 110-129 lbs, 5 ft 0 in to 5 ft 3 in, Blue Cross/Blue Shield, DD cup, insurance

I'm 16, 120 lbs, 5'3", with 32DD breasts who wants to go down to a32B. I've found a surgeon, and gotten a consult. The plastic surgeon said that I would have to have more tissue taken out than I have in order for insurance to cover it. I sent in a pre-approval request, made out by my general practitioner, to my insurance company, Blue Cross/Blue Shield of Alabama. Does insurance pay for the surgery before it is done, or do you pay out of pocket and they reimburse you?

16 answers to How Does Insurance Coverage Cover Breast Reduction Surgery?

Generally insurance pays the bills and you pay the balance

Generally the insurance company pays their share and you pay yours. Sometimes you have to pay the co pay up front. It depends on your insurance policy . Your surgeon and her or his staff will assist you with these issues. Good Luck! Dr Grant Stevens

Grant Stevens, MD
Los Angeles Plastic Surgeon

marinaplasticsurgery.com

How Does Insurance Coverage Cover Breast Reduction Surgery?

Every insurance plan is different, and I cannot tell you specifically whether you would be covered under your plan or not. Some plans require a certain minimum amount of tissue be removed, usually based on your height and weight. Some plans require a demonstration of failure to more conservative approaches such as physical therapy. Some plans offer no coverage at all. Your surgeon can ask your insurer for a predetermination of medical necessity to find out in your case. This will usually... more

Mark Preston, MD
Columbus Plastic Surgeon

Breast Reduction and Insurance Coverage

Hi Sarah101, Each insurance company is different and, not surprisingly, it is become harder and harder to get insurance companies to pay for this procedure. In general, though, they will cover the procedure if you can show that removing the indicated amount of tissue (more on that below) will be likely to alleviate certain specific symptoms. In general, the procedure has to be performed before any payment is made. Depending on the exact insurance company, the payment will... more

Alan Engler, MD
New York Plastic Surgeon

Insurance coverage for breast reduction surgery

Insurance coverage for breast reduction varies from state to state. Most carriers require a letter from the plastic surgeon estimating the amount of breast tissue to be removed, so the letter from your primary care physician will not contain sufficient information to allow them to make a decision. Your plastic surgeon will need to send a letter to the insurance company, who will them decide if your case fulfils their criteria for coverage. This needs to be done before... more

Beverly Friedlander, MD
Short Hills Plastic Surgeon

Breast Reduction Insurance Coverage?

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. It is one of the most patient pleasing operations we perform. Based on your description you may be a good candidate for breast reduction surgery; for physical and emotional reasons. 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... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Insurance for breast reduction

Usually i will document the patients condition take photos and send a letter to the insurance company for prior approvalOnce that is done you can have the surgery and the insurance company will pay the doctor.

Robert Brueck, MD
Fort Myers Plastic Surgeon

www.beauty-by-brueck.com

Breast reduction and insurance

Every doctor's offie works differently. Some under the plans will take the insurance as full payment. Others not "in -the plan" will expect full payment either before or after surgery. As for coverage you have to check with yoru insurance company. Good luck.

Steven Wallach, MD
Manhattan Plastic Surgeon

Breast Reduction, what is needed for insurance coverage

In my experience, women who are a double D will qualify for insurance coverage. Most insurance companies require that a minimum of 500 grams per breast is needed for removal to qualify. I would suggest that you seek another opinion from a Board Certified Plastic Surgeon since the one you went to doesn't think you qualify. But different insurance companies have different requirements. Some will want documentation that you have been seen by a physical therapist, and have tried special... more

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon

www.dr-delgado.com

Breast reduction

This depends on your plan. Generally, insurance companies require a certain amount to be removed. If the amount removed is less than the minimum, then you may be asked to pay for the entire cost. Going from a Dd to a B should be covered, but that again depends on each state's requirements.

Shahin Javaheri, MD
San Francisco Plastic Surgeon

Breast reduction through insurance

Breast reduction is covered by insurance with certain plans. The first step is to review your plan book to find a plastic surgeon in your plan network that accepts your contracted rates. Next the surgeon will complete a consultation and obtain a written predetermination with your plan to confirm that the surgery is a covered benefit. If so your procedure will be covered. Contracted surgeons are often prevented from collection of allowed charges 'up front' so check with... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

Breast Reduction Criteria for Insurance Coverage

Your surgery should be covered under insurance- but it may be difficult to get it approved. Insurance precertification needs to be performed by your surgeon and you will need to have written approval before proceeding with surgery lest you get stuck with a bill. Given your height/weight ratio and calculated against the Schnurr Scale (which is BC/BS's volume reduction calculator), you need less than a 300 gram reduction on each side to qualify with BC/BS's criteria. Documentation... more

Derek Lou, MD
Houston Plastic Surgeon

Breast reductions and the Schnur scale

Many insurance companies use the Schnur Table (Google it...) to determine the minimum that a surgeon needs to remove from each breast in order for the insurance company to pay for the procedure. In smaller women like yourself, this is sometimes difficult to leave you with enough breast tissue for a good cosmetic result. Insurance companies do not pay for cosmetic surgery (nor should they...)

Scott Sattler, MD
Bellevue Plastic Surgeon

Questions on approval for a breast reduction

Typically, your plastic surgeon will obtain or attempt to obtain authorization for your breast reduction. If it is approved, then what your financial responsibility is depends on your particular plan which you will need to check out. He/she will be paid directly by the insurance. If you can not obtain approval due to an inadequate amount of breast tissue that needs to be removed (according to the particular insurance plan), then you have the option of proceeding by paying for it yourself... more

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon

www.turkeltaub.com

Insurance for breast reduction

Unfortunately insurance companies don't make it easy for women who need breast reduction to get that breast reduction. In some cases they are covered but those are usually very dramatic situations. It sounds like you may be on the side of less dramatic so you may have to work extra hard to get it covered and in some cases it is just impossible. Think of it this way, if the reduction is for aesthetic reason, it is not going to be covered. The insurance company has to believe it is for... more

Andrew Kaczynski, MD
Sacramento Plastic Surgeon

www.drkmd.com

Insurance Coverage Of Reductions Vary

Different insurance cos. have differing criteria on their coverage of reductions and some have an outright exclusion. It would seem that going from a DD to B cup would result in a weight adequate for your procedure to be covered, although you are at a disadvantage because of your petiteness. Insurance3 cos. should inform you pre-operatively if they will cover the surgery. You might want to obtain a second opinion.

John Whitt, MD
Louisville 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 policies will pay for breast... more