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Will Insurance Pay for a 16 Yr Old with 42DD Breasts to Get a Reduction?

asked 1 year ago by D.C. in Leeton/Warrensburg, MO
Latest answer by Tom J. Pousti, MD
Question viewed 919 times
Tags: age 17 or under, 150-169 lbs, 5 ft 4 in to 5 ft 7 in, DD cup, insurance

She is only 5'4 1/2" and weighs 160 (at least 20 lbs would be her breasts). She has not grown physically in the last two years more than 1/2", so her chest looks grossly out of proportion to her body. She also is developing a hunchback and pain in her shoulders. She's also cheerleading this year and they are seriously getting in the way. Also, is there a doctor at Children's Mercy in Kansas City you could recommend?

12 answers to Will Insurance Pay for a 16 Yr Old with 42DD Breasts to Get a Reduction?

+1

Breast Reduction for 16-year-old?

Thank you for the question. I'm glad to hear that your daughter has your support; this this will be very helpful to her. It sounds like she is dealing with juvenile breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for the frame causing both physical and psychological distress. As she thinks about breast reduction surgery make sure she does her homework... more
Tom J. Pousti, MD

San Diego Plastic Surgeon
+1

Breast reduction

Every insurance company has different requirement in order to cover breast reduction. E age could also be a factor. 16 is the youngest that i will perform a breast reduction.
David L. Abramson, MD

New York Plastic Surgeon
+1

VIDEO (Click here) Breast Reduction and insurance coverage.

It is best to go in for a consultation and have the surgeon draft a letter of predetermination of benefits to your insurance carrier to help ascertain your level of coverage. see video
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+1

Breast reduction coverage for a 16 year old

What insurance companies deem necessary for surgery is not always what we as plastic surgeons think is necessary.  In all cases a consultation with a board certified plastic surgeon is required.  The surgeon will then submit his or her recommendations to the insurance company.  Many times supporting documentation is necessary to substantiate the medical reasons for the surgery to meet the insurance companies criteria.
Randy Proffitt, MD

Mobile Plastic Surgeon
+1

Will health insurance cover breast reduction?

In your situation, probably yes, but the best way to find out is check the provisions of your policy (online or by phone), and visit her primary care physician for referral to a plastic surgeon.
Steve Laverson, MD

San Diego Plastic Surgeon
+1

Breast Reduction Covered by Insurance

Yes, sometimes insurance will cover these types of procedures depending on the Insurance company and the severity of the case. I would recommend contacting your insurance company to get their requirements, as they vary greatly between companies.
Robert N. Young, MD

San Antonio Plastic Surgeon
+1

Breast reduction is medically necessary

Breast reduction, when medically necessary, is covered by most insurance plans.  This will require you doctor to submit information, and even photos, to the insurance company to receive a pre-determination of coverage.  From your description, breast reduction may be medically necessary in this individual.  I suggest you see two or three plastic surgeons for opinions.
Daryl K. Hoffman, MD

Los Gatos Plastic Surgeon
+1

Breast reduction

It is certainly possible that your daughter may be a candidate for a breast reduction. But without seeing her it is impossible to say.  You can check with your  insurance company regarding coverage.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Macromastia in Teenager

It is possible to have a Breast Reduction under your insurance if you have back pain, neck pain, inability to exercise and other symptoms related to the large  breasts. You would need to check with your insurance company and go to a Plastic Surgeon as listed on your plan. 
Hayley Brown MD

Henderson Plastic Surgeon
+1

Juvenile Breast Hypertrophy

Macromastia in teenagers is also known as Juvenile Breast Hypertrophy. Breast reduction for this condition is indicated and is almost always covered under most insurance plans. My insurance authorization team has been very successful getting these types of operations covered. This can always be determined prior to surgery by contacting your insurance company.
Kevin Brenner, MD

Los Angeles Plastic Surgeon
+1

Insurance Pay for a 16 Yr Old with 42DD Breasts to Get a Reduction

Yes this can be an insurance covered benefit. Check with your insurance plan to find a plastic surgeon provider who will know how to get  a clearance for surgery. Otherwise ask the primary doctor to refer you to a plastic surgeon. 
Darryl J. Blinski, MD

Miami Plastic Surgeon
+1

Insurance coverage for breast reduction 16yr old

Large breasts can restrict your lifestyle and cause a variety of medical problems. Even drastic weight loss won't result in more than negligible shrinkage. Breast reduction surgery removes excess breast tissue and reshapes the contour of the breasts so that they are smaller and perkier. Congenital breast deformities and severe breast asymmetry as well as Breast reduction for large breasts is usually covered by insurance when the surgery is performed as part of a medically mandated... more
Michelle Copeland, MD, DMD

New York Plastic Surgeon

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