Ask a doctor

How Long Does It Normally Take BCBS-IL to Confirm or Deny Coverage for a Breast Reduction?

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?

Doctor Answers (2)

Insurance

+1

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.

Best wishes,

Dr. Basu

Houston, TX


Houston Plastic Surgeon
4.5 out of 5 stars 117 reviews

Insurance coverage for breast reduction

+1

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.

Margaret Skiles, MD
Sacramento Plastic Surgeon
3.5 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.