Mild Degenerative Disc, Will Insurance Help?

hi, i'm 4 9" and i weigh 133 and my bra size is 32 j ( 9 times D). im taking treatment for back pain, i'm considering breast reduction surgery, i did an xtray which shows that i have mild degenerative disc changes with straighting, what does this mean? and would my insurance denied my surgery if i show them this result or would it help me get it?..i suffer from back neck and sholder pain, pain in my breast when i run, jump or take my bra off...

Doctor Answers (7)

Breast reduction IS covered by insurance when medically justified

+2

Breast reduction is covered by insurance when medically justified, and from the sound of your story it seems that it is absolutely justified in your case. Although you may require evaluation and treatment for you disc problem, breast reduction will likely improve your back problems too.


Beverly Hills Plastic Surgeon
5.0 out of 5 stars 15 reviews

Breast reduction often covered by insurance.

+1

Hi.

It sounds like you will be able to get insurance coverage, and these X-rays will help.  There is an article in my RealSelf profile about this which you may find helpful.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast Reduction and Insurance Coverage?

+1

Thank you for your question. Based on your description you may be an excellent candidate for breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.

However, it is not possible to predict whether a specific insurance company will authorize the procedure.  
 Your best bet is to seek consultation with board-certified plastic surgeons. Ask to see lots of examples of their work. The plastic surgeon you select will be able to submit your information to the insurance company on your behalf. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.


 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 791 reviews

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Insurance Coverage for Breast Reduction

+1

     Given your height, weight, breast size and symptoms, you would be a candidate for breast reduction and insurance coverage, provided your insurance provider covers breast reductions.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 237 reviews

Insurance coverage for breast reduction

+1

I believe that you will be covered.   A "J" cup qualifies as gigantomastia, rather than regular macromastia, and the insurance companies, recognizing the consequences, tend to be much more cooperative in these cases. You will need to supply your plastic surgeon with supporting medical records for the preauthorization.  The operation will do you a world of good!

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 13 reviews

Even though breast reduction is most often a functional operation insurance coverage is always questionable.

+1

The willingness of insurance companies to cover breast reduction is uncertain. Prior approval based on multiple parameters will determine the individual case.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 10 reviews

When does Insurance Cover Breast Reduction

+1

Dear bsadya,

If you have a history of back pain related to the weight of your breasts, this is an indication for surgery to be covered by your insurance carrier.

If you are 4'9" and 133 lbs and wearing a J cup, you will likely be a candidate for breast reduction surgery covered by your insurance company.

It's important that you see a plastic surgeon and have him/her document all the problems you have related to the weight of your breasts. The plastic surgeon will write a letter to your insurance company based on what you've discussed and will make a determination about coverage. Unfortunately, even there is significant literature supporting the medical benefits of breast reduction surgery, insurance companies still don't guarantee coverage.

Best of luck to you.

David Cangello, MD
New York Plastic Surgeon
5.0 out of 5 stars 7 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.