Seek Second Opinion Regarding Breast Reduction Insurance Coverage?

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?

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age 25-34 breasts DDD cup female 5 ft 4 in to 5 ft 7 in weight loss 170-189 lbs insurance plastic surgeon

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9 Doctor Answers | Asked by csyhd in olean ny

Doctor Answers (9)
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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!

Second Opinion helpful for Breast Reduction Insurance Coverage

Yes, the more consultants that recommend breast reduction the better your chances for coverage. Here are some tips for getting coverage:Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company. In your case: The more Physician recommendations for breast reduction the better - that would include your gynecologist, primary care doctor, plastic surgeon, chiropractor, etc. They want to see that you have already tried non surgical means such as... more

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

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

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

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.

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

12 reviews

Manhattan Plastic Surgeon

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!

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