Where to Start with Insurance Coverage?

Where should I start if I want to get breast reduction covered by insurance? I'm 30 years old, 134 pounds and 34DD. I have always had headaches and backache due to my breasts.

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5 Doctor Answers | Asked by jesst7

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Insurance Criteria for Breast Reduction Varies between Companies

Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company. Contact your individual company and request their specific Criteria. Here is some general information however to help you :Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for... more

Insurance Coverage

The first step is to see if your insurance company's requirements for coverage is online. If not, a call to the insurance company to get an understanding of requirements is useful. Consult with a board certified plastic surgeon to verify that you are a candidate for a breast reduction and to ensure that you fall within the requirements of your plan. At some point, it is useful to get independent verification that the surgery is medically necessary. You can either meet with your primary care... more

Get a consult first

It would be nice if insurance companies posted their info on line, but most don't. See a board certified plastic surgeon first and go from there.

Breast Reduction and Insurance Coverage?

Thank you for the question. Based on the description of your body type and symptoms, you may be an excellent candidate for breast reduction surgery. I think the best place to start would be with in person consultation with board-certified plastic surgeons. A phone call to your insurance company will also be helpful.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... more

Beginning with insurance coverage

Now that so much information is on the internet, I recommend beginning online. Your insurance company's criteria for breast reduction should be posted online so read and review them. This will give you a starting point. If your insurer expects documented medical management, the types of management (pain medication, orthopedic treatment, physical therapy, etc.) will be spelled out in the alternative and also the number of months of treatment required will be made clear. Once you understand... more