Does United Health Care Cover Breast Reduction?

This procedure is commonly covered by insurance though insurance
criteria are becoming more and more restrictive. You need to contact United Health Care directly Although we do not accept
insurance, our staff will assist you in obtaining pre-authorization so that you
can attempt to be reimbursed for out of pocket expenses

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 the operation if more than 400 – 500 grams are
removed from each breast dependent on your individual insurance company
requirements. These problems may include #neckpain, back or shoulder pain,
hygiene difficulty, and #breastpain. Other problems which are less likely to be
covered by insurance include skin irritation, skeletal deformity, breathing
problems, psychological/emotional problems, and interference with normal daily
activities. Pre-authorization by the insurance company is required prior to
surgery, and the process takes approximately one month. Each insurance policy
has different guidelines and exclusions.

Depending on your situation, insurance may be able to subsidize the cost of breast reduction. Some breast reduction coverage requirements where I practice in Ontario include your current cup size, the amount of breast tissue removed during surgery, unsuccessful experiences with alternative treatments and medications, as well as recommendations for breast reduction from other specialists, such as chiropractors and neurosurgeons.Please see an experienced board certified plastic surgeon to find out whether you are a suitable candidate for breast reduction first. You will most likely have to wait at least 6 months or so after you've stopped breastfeeding before you can pursue surgery. Breast reduction may inhibit breast feeding, although this is just a risk and not guaranteed.

Your best bet is to find a participating surgeon and go in for a consultation and have a predetermination of benefits letter composed to ascertain your level of coverage.

Wait a few months after you have completed breast feeding to allow your breast tissues to resume their typical size, weight and skin quality. If you are able to provide the documentation required by United to pre-approve your breast reduction, you should be able to get it done. Seek out a board certified plastic surgeon for assistance with the process.

Thank you for the question.

Most breast reduction procedures involved leaving a certain amount of tissue intact to supply blood flow to the nipple/areola;  this tissue is called the pedicle. These “pedicles” can bring blood flow from above (superior)  or from below (inferior). It is the presence of this breast tissue that makes breast-feeding an option for many patients who have undergone breast reduction surgery.

I am not aware of any studies that show one technique demonstrating a higher rate of success of breast-feeding. It may be difficult to quantify since some ladies are not able to proceed, without having had breast surgery at all.

I hope this helps.

This is always a tough question.If a patient is symptomatic then usually yes.Insurance companies usually take your weight and height and have a formula to decide how much breast tissue needs to be removed.Many times people come in who are overweight AND have large breasts and the insurance company will say lose 40#.I tell my  patients insurance companies want to deny claims so they can hold on to your money.I would complete my nursing and allow the breasts to settle before considering a breast reduction.also you probably will NOT be able to breast feed in the future if you should become pregnant.

You will need a consultation to determine if you meet the insurance requirements for a breast reduction.  All of the insurance have different criteria for approval but in general they require that approximately 500 grams of breast tissue are to removed along with symptoms related to large breasts.  These may include large heavy breasts, painful breasts, inability to exercise due to breast pain, back neck and shoulder pain and rashes under the breasts.  Also some mention of non-surgical methods attempted to relieve the symptoms such as support garments and physical therapy. 

You may very likely meet the criteria set by yoru insurance company, but you should really check with them first.

If you meet the requirements as stated by United Health Care than YES they will cover the surgery. But not while you are breast feeding. Seek a boarded plastic surgeon provider for United in the United Provider handbook. 

Congratulations on your baby.  Of course, any breast reduction would need to wait until a few months after you are done breastfeeding.  Around that time, you should seek a consultation with a surgeon who is certified by the American Board of Plastic Surgery regarding breast reduction.  United Healthcare does often cover medically necessary breast reductions, and your surgeon will be able to guide you through the process.  Best wishes!