5'2", 140lb, 36DD - Am I a Candidate for Breast Reduction?

Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.Best wishes,Dr. BasuHouston, TX

From your description, you will certainly benefit from a breast reduction. BUT I would definitely meet with a plastic surgeon and look at before and after to determine if you will be okay with the incisions. There are many issues to resolve and it is best done with both you and another family member present.  Getting breast reduction covered under insurance is very difficult. In fact getting them to tell you, as the consumer, the number of grams needed to get coverage will be nearly impossible. I suspect in the end it will have to be paid out of pocket.  The insurance frequently places the restrictions and makes it difficult without any medical substantiation. I have had many difficulties with my own patients (who truly needed it)  getting coverage. The best way to get coverage is to call your insurance company (my patients really raised a stink)...remember you are the consumer and you are asking insurance to cover a procedure that your doctor deems is medically necessary.