What Are the Steps to Getting a Breast Reduction Approved by my Insurance?

Age: 20 Height: 5'2 1/2" Weight: 120 lbs. Bra size: 32 H I experience a lot of back pain especially in my shoulders. My bra straps often dig into my shoulders. I often feel pulling on my chest area because they are so heavy. I am concerned as to what size they would take them down to, what scarring there could be, what complications could occur, and what my experience would be post-op. I am also a recovering addict so pain medication is something I would have to refuse post-op.

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5 Doctor Answers | Asked by siciliaxo

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Breast Reduction Concerns…

Based on your description you may be a good candidate for breast reduction surgery; this operation is one of the most patient pleasing operations we perform. 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 doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. This documentation... more

Breast Reduction

See a plastic surgeon -- talk to them , they should take photos and then you can contact your insurance company with them. If you have consults from internist showing back pains it might help. The insurance companies are becoming more difficult.

Steps to insurance approval of breast reduction

The criteria for your insurance company should be posted on its website. Many insurers now require proof of at least six months`conservative management. However, in cases of gigantomastia, some carriers waive this. A great deal of the information you are seeking can be found on, the site for the American Society of Plastic Surgeons, as well as on RealSelf. In terms of the drug use history, you may not be a happy camper for a couple of days, but extra strength Tylenol may be effective. You... more

Surgeon Needs To Communicate With Ins. Co. For Reduction Approval

It certainly sounds as if you would benefit from a breast reduction. You should obtain a consultation with a board-certified plastic surgeon who can then communicate with your insurance company to get prior approval. Congratulations on your recovery!

Breast reduction coverage by insurance

You should have a consultation with a board certified plastic surgeon. After He/She has examined you and established medical necessity, your insurance company is contacted for preauthorization. Discussions of risks and benefits of surgery including postoperative size needs to be done in person with your surgeon. Best of luck.