Will MedicAid Cover Reduction of DD Breasts?

I am a 23 year old single mom who suffers from severe back and shoulder pains and horrible posture as a result of my 38DD breasts. Is it possible my MedicAid insurance may cover the procedure?

Doctor Answers (7)

Breast Reduction and Medicaid?

+1

Thank you for the question and picture.

Although you may be an excellent candidate for breast reduction surgery I think the biggest challenge  you will have is finding a reputable plastic surgeon who works with Medicaid.

Best wishes.


San Diego Plastic Surgeon
5.0 out of 5 stars 701 reviews

Medicaid coverage for breast reduction.

+1

Breast reduction surgery is covered by Medicaid if certain criteria are met, and these criteria must be met completely and exactly or coverage will be denied. First, discuss with your chosen plastic surgeon what the Medicaid criteria for coverage are. These will be listed in your information packet, or will be available if you ask. For Medicaid and most insurance companies, these criteria are now quite similar, and most are based on your height and weight (not just subjective complaints of back pain, neck pain, bra strap grooves, rashes under the breasts, and possible numbness from bra strap pressure on brachial plexus nerves, even if documented by your chiropractor or regular physician). A formula that Medicaid uses (your plastic surgeon knows this) can tell you just how much breast tissue needs to be removed in order to qualify for coverage. Any amount less than this specified amount will cause the bill to become your responsibility.

Your surgeon should be able to tell you this BEFORE surgery, and you should not assume that coverage will be automatic unless you are willing to be "too small" after the required amount of breast tissue is removed (or be "the requested size" and end up being responsible for the entire bill out-of-pocket since the mandated amount was not removed).
 

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 116 reviews

Breast Reduction Surgery

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You should check with medicaid to determine their specific criteria for considering coverage for your breast reduction surgery. Consult with a board certified plastic surgeon to determine if you are a candidate. Best wishes!

Christine Sullivan, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 18 reviews

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Medicaid and breas reduction

+1

Medicaid may ver y well cover your breast reduction surgery provided that you are a good candidate.  You can check with them for their criteria.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 16 reviews

Medicaid coverage for breast reduction

+1

Our breast reduction patients are some of our happiest patients. They appreciate their new look and literally have had a significant weight taken off their shoulders. As you know, some insurance policies may cover this procedure. However, it depends on the insurance policy and the insurance company. In our practice, we have seen many insurance companies do everything possible to avoid paying for medically necessary procedures such as a breast reduction. If you are not able to have your breast reduction covered by an insurance company, work with a board-certified plastic surgeon who has a great deal of experience in breast reduction and breast contouring and inquire about financing plans. In our practice, our patient coordinators are experts at finding a plan that will fit the patient's budget.

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 64 reviews

Insurance coverage for Breast Reduction

+1

Breast reduction is often covered by insurance comapnies.  You will need to speak with your insurance representative and find a surgeon that will accept your coverage. 

Sean A. Simon, MD
Miami Plastic Surgeon
4.0 out of 5 stars 27 reviews

Insurance and breast reduction

+1

You will first need to find a local

plastic surgeon

that works with your insurance provider and then schedule an appointment. Every carrier is different in what or if they will cover

breast reduction

surgery and what hoops they want you to jump through first. Often times it will be required that you have a round of conservative treatment such as physical therapy or even a chiropracter. You need you primary care provider to document well what your symptoms are as well. As equally important is to meet with the plastic surgeon who can advise you on your best options. Take care.

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 11 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.