6 Steps to Speed Insurance Coverage for Breast Reduction


The process of seeking prior authorization for Breast Reduction can be very frustrating because many insurance carriers have developed more rigid guidelines prior to approval. I have performed over 2,300 breast reduction cases, and my staff and I have developed a protocol that we have found very helpful in 1. reducing the time for approval and 2. increasing the percentage of those patients that have received approval for breast reduction procedures. Below is our step-by-step approach to seeking prior insurance authorization:

  1. Seek your consultation with a surgeon that is board-certified by the American Society of Plastic Surgeons who has performed a high volume of breast reduction cases and is familiar with the process of insurance authorization.
  2. Have all of your documentation including: your insurance information, all of your symptoms, any input from you primary care physician regarding your symptoms, any conservative measures that you have employed to reduce your symptoms, and, if you are older than 40, the results of your most recent mammogram, forwarded to your Plastic Surgeon prior to your consultation.
  3. Document your symptoms well. The most common findings  associated with enlarged breasts are:
    1. Bra strap irritation
    2. Upper and lower back problems
    3. Neck strain
    4. Chest wall heaviness
    5. Rashes beneath the breasts
    6. A decrease in overall activity levels because of the above
    7. Overall difficulties during your employment because of your breast size
  4. Provide a complete list of the conservative measures that you have employed over the past year to improve your symptoms:
    1. Physical therapy: massage, heat treatments for the back
    2. Chiropractic care
    3. Medication for back soreness: Tylenol, muscle relaxers
    4. Special support garments employed
    5. Documentation from your primary care physician regarding your symptoms
  5. Match a reasonable weight relative to your height
  6. During your consultation your physician will review all of your documentation, perform a detailed examination, and forward a letter including your photographs to your insurance carrier.

If the above guidelines have been met, we see coverage within 2-6 weeks. If there has been inadequate documentation provided, the approval process may require 4 to 8 weeks. Depending on the insurance carrier and the physical examination findings, our approval rate over a 30 year period has been 70 to 85%. 

Article by
Eau Claire Plastic Surgeon