How Does Insurance Coverage Cover Breast Reduction Surgery?

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?

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age 17 or under DD cup 5 ft 0 in to 5 ft 3 in 110-129 lbs Blue Cross/Blue Shield insurance

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16 Doctor Answers | Asked by Sarah101 in Florence, AL

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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

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

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

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

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

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.

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

12 reviews

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

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.

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