Breast Reduction Q&A
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Likelihood of Insurance Coverage for Breast Reduction?

asked 4 months ago by lkg7
Latest answer by Miguel Delgado, Jr., MD
Question viewed 158 times
Tags: DDD cup, insurance, pain, probability

I am 20 years old, about 5'8'' and weigh roughly 135 lbs. I am a size 34DDD and am really interested in getting a reduction. If I document any pain/discomfort, anything I seek for the pain such as a chiropractor or acupuncturist, etc., what is the likelihood of my insurance covering the surgery?

8 answers to Likelihood of Insurance Coverage for Breast Reduction?

+1

Likelihood of Insurance Covering Breast Reduction Surgery

In my experience, usually a woman with DD or larger will qualify for insurance coverage, if it is a covered procedure under their policy. Most insurance companies require removal of 500 grams or more per breast. All documentation helps in getting approval, including good support bras you have tried, physical therapy and even pain medication. See a Board Certified Plastic Surgeon who specializes in breast reduction surgery, and your surgeon should know how to request pre-authorization from... more
Miguel Delgado, Jr., MD

San Francisco Plastic Surgeon

www.dr-delgado.com

+1

Insurance coverage for breast reduction

I am biased on this question because I gave up any third party payment of plastic surgery procedures although I still do breast reductions. I do them because the patient wants them and understands what is involved including the cost and we don't have to go to someone else for permission. Breast reduction is an example of an elective procedure that has both functional and cosmetic aspects and can be considered medically necessary but not like a condition such as breast cancer.... more
Scott L. Replogle, MD

Denver Plastic Surgeon
+1

Breast Reduction and Insurance

Your chances are very likely. Most insurance companies look for a documented history of back, neck or shoulder pain and some prior treatment which has failed. They look at your height and weight and plug this into a formula. It sounds like you would easily qualify. Check it out and stop suffering. Your surgeon should get a detailed medical history because some health-care providers demand a history of treatment for back pain to authorize coverage. I measure the... more
Joe Gryskiewicz, MD

Minneapolis Plastic Surgeon
+1

Breast reduction insurance approval

In order to determine insurance coverage for a breast reduction you would need to be evaluated by a plastic surgeon. Taking into account your height and weight as well as your breast size in addition to the symptoms you describe you will likely qualify for a breast reduction. It is possible for you to call your insurance company and ask a claims manager what is the method that is used to approve a breast reduction. Much of this information is available on line if you know... more
Jeffrey Zwiren, MD

Atlanta Plastic Surgeon
+1

Insurance coverge for breast reduction

Many insurance companies will cover large breast reductions but you should really ask your insurance compnay what theor criteria are. Insurance companies are all different.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Insurance not likely to cover breast reduction

Normally, a triple D breast would not qualify for an insurance-covered breast reduction surgery. It all depends on documentation and your insurance carrier. Good luck.
Donna Rich, MD

Houston Plastic Surgeon
+1

Insurance Coverage For Reduction Varies

There is no uniform set of criteria for insurance coverage for breast reductions which varies a lot from company to company and also from state to state. Some policies even have outright exclusions for reductions regardless of symptoms. In most cases your reduction would be covered if smptoms are well documented and if a sufficient amount of tissue is removed.
John Whitt, MD

Louisville Plastic Surgeon
+1

Breast Reduction and Insurance Coverage?

Thank you for your question. Based on your description you may be an excellent candidate for breast reduction surgery; it is one of the most patient pleasing operations we perform. 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... more
Tom J. Pousti, MD

San Diego Plastic Surgeon

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