Breast Reduction Q&A
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Seek Second Opinion Regarding Breast Reduction Insurance Coverage?

asked 2 years ago by csyhd in olean ny
Latest answer by Alan Engler, MD
Question viewed 580 times
Tags: age 25-34, breasts, female, 170-189 lbs, 5 ft 4 in to 5 ft 7 in, weight loss, DDD cup, insurance, plastic surgeon

Hello. I am 28 years old and am about 5'5" tall and weight around 180lbs which I have lost a lot of weight. My breast size is a 38DDD and I have a lot of irritation under them and a lot of shoulder and back pain.

I recently hurt my back the doc said it was a joint in my lower back the pivots and sticks. I asked about Breast reduction and he said medicaid won't pay for it because I have not complained enough or went to a doctor enough. Should I find another doctor?

8 answers to Seek Second Opinion Regarding Breast Reduction Insurance Coverage?

+1

I agree with Dr Rand.

Go to one of the teaching hospitals in your area and see if they will take Medicaid. The payments do not cover the costs of doing the surgery in private practice. Good Luck!
Grant Stevens, MD

Los Angeles Plastic Surgeon

marinaplasticsurgery.com

+1

Breast Reduction - Insurance Coverage

This is clearly a question that comes up frequently. Whether or not an insurance company will pay for breast reduction surgery depends on many factors, but chief among them are your height and weight, as compared your breast size now and what size you would be reduced to. In your case, an insurance company might want you to lose some weight first and, at that point, you may not be able to have enough of a reduction to balance both their requirements and what you would want and need... more
Alan Engler, MD

New York Plastic Surgeon
+1

Breast Reduction Insurance Coverage?

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. It is one of the most patient pleasing operations we perform. Based on your description you may be a good candidate for breast reduction surgery; for physical and emotional reasons.
The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care... more
Tom J. Pousti, MD

San Diego Plastic Surgeon
+1

Insurance coverage for breast lift or breast reduction.

Answer by George J. Beraka, MDManhattan Plastic Surgeon80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points. 1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches. 2) Very big reductions (like from an F cup to a C cup) will usually be covered. 3) Many policies will pay for breast... more
George J. Beraka, MD

Manhattan Plastic Surgeon
+1

Breast reduction by Medicaid

Most top plastic surgeons won't do Medicaid reductions anymore because the payments are exceptionally low, even lower than the cost to the doctor to do the surgery. Consequently, since there are many excellent plastic surgery training programs in NY ie. NYU, Cornell, you should go to one and seek care there.
Richard P. Rand, MD, FACS

Seattle Plastic Surgeon
+1

Breast reduction and insurance

Breast reduction can often be covered by insurance. If you have significant neck and back pain and yaour breast are very heavy, you may get coverage. You need supporting documentation that your symptoms have not improved with conservative management.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Seek second opinion regarding Breast Reduction insurance coverage

That is correct. "Medicaid" are very poor payers and very difficult to achieve a pre operative determination for coverage. I recommend you go to a University Hospital that has a department of Plastic Surgery, there you might have an easier time. Regards!
Darryl J. Blinski, MD

Miami Plastic Surgeon
+1

Breast reduction insurance coverage

Your doctor is right in that you need to show a pattern of symptoms due to large breasts that have been treated but not improved. Insurance companies always want to see some prior treatments in an attempt to improve the pains with out surgery. See a physical therapist for your shoulder and back pains and see what improvement can be gained with this therapy. If the therapists says he can not help you because your breasts are too big then you have you answer for the insurance company. Best... more
Marcus L. Peterson, MD

Saint George Plastic Surgeon

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