I am 21 years old I have always had big breasts but after having my son in 2008 they went from a E cup to a 48 L and continues to go up, I have tried to lose weight and my breasts always stay the same, I also have chest and back pains. Will they cover it based on everything I am posting here.
Will Medicaid Cover a Breast Reduction in Illinois?
Doctor Answers (6)
I'm not sure about your state medicaid, but I can comment about private insurance coverage. Every insurance plan has their 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.
Thank you for the question.
It sounds like you are dealing with 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.
I would suggest you do your homework and understand the potential risk and complications associated with breast reduction surgery, including abnormal scarring. You also understand that further surgery may be necessary in the future (for example if the breasts were to grow in size again).
Timing of the breast reduction surgery is based on the patient's psychosocial place in life and is a very individual- specific decision. She must be able to accept the scars (which result from the breast reduction surgery) in exchange for the improvement in size/contour/position of the breasts. Some patients choose to have the breast reduction surgery earlier in life; some patients prefer to wait until they are in mature/stable relationships and/or have completed having pregnancies.
Given that the results of surgery will be with you for a lifetime I would suggest you save up and have the procedure done by the best board certified plastic surgeon you can find. You may find that most well-trained/experienced board-certified plastic surgeons cannot participate in the Medicaid programs.
I hope this helps.
Breast Reduction and Insurance Coverage
Yikes! I think anyone would agree that that's pretty large!
Insurance coverage for breast reduction varies widely from plan to plan but, in general, the larger you are (relative to your overall body size, or body mass index) the more likely they are to be willing to cover it (ie, pay for it). That's the good news.
The bad news is that you now have to find a surgeon who would be willing to accept the insurance payment as an adequate payment for the surgery. Unfortunately, as payment for this procedure has dropped over the last few years, there are fewer and fewer surgeons who are willing to do so.
Your best bet is probably to contact a local medical center and see if there is a plastic surgery clinic. You will probably be able to get it done that way, although I cannot, of course, give any specifics without being able to examine you.
But I hope that this helps, and good luck,
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Medicaid in Illinois and breast reduction
Illinois Medicaid does not pre-approve breast reduction and may not pay after surgery. So many patients in this situation discuss a self pay option for this procedure.
Breast reduction coverage
Every insurance company is a bit different with regards to coverage for a breast reduction. You should contact your insurance company to find out their criteria.
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.