I am 17, 5'3, a bit less than 150 lbs, and a 38F. I have little doubt that I am a good candidate for this surgery, the problem is the insurance coverage. I, ideally, want to have the surgery in December, but I fear it may take until November to get to my goal weight, 130-135 (I've already lost 15 lbs). Do I have to get down to that weight before insurance will even consider it? And if I do, with losing the weight and applying for coverage in November, is mid-December a realistic surgery date?
How Long Does It Normally Take BCBS-IL to Confirm or Deny Coverage for a Breast Reduction?
Doctor Answers (2)
Every insurance plan has there 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.
Insurance coverage for breast reduction
Every insurance company has difference policies so it is hard to generalize. I tell my patients that it usually takes 4-6 weeks. If you want your surgery in December, now is probably the right time to see a plastic surgeon certified by the American Board of Plastic Surgery and have your consultation to start the process. He or she will be in a much better position to know what your insurance company requires. Good luck to you.
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