Im 5'3'' 136lbs, 34DD. Just Wondering if Alberta Health Will Cover This?

I went to my family doctor and he passed on a referral.Just waiting to hear back for a consultation date. Do I have a chance of getting my breast reduction covered? i do suffer from back pain, have grooves in my shoulders, constant headaches and they are saggy. Are my breasts "too small" to be covered?

Doctor Answers 5

Insurance coverage

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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. Basu
Houston, TX

Breast reduction and insurance

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Based on your measurements you seem to need, and be a great candidate for a breast reduction. 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...remember you are the consumer.

Breast reduction

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It is impossible to tell without photos whether you are a good candidate and if insurance will cover it.  Howver, the fact that you had been referred to a plastic surgeon is a good start. I'm sure the plastic surgeon you are will see deals with the Canadian health system and will be able to tell you better than a US surgeon can. Good luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 31 reviews

Breast reduction

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Thank you for the question. Breast reduction is indicated in patients with symptoms similar to the ones you described and having breast hypertrophy. The decision is usually made after taking complete history and doing physical exam. Without examination, it would be difficult to give you an answer. 

Moneer Jaibaji, MD
San Diego Plastic Surgeon

Breast Reduction and Insurance Coverage?

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Thank you for the question.

Unfortunately, you will have to wait until your consultation for a good idea of whether your breast reduction procedure  may be covered by health insurance. Online consultants, without the benefit of examination or pictures will not be able to guide you.

Generally speaking, breast reduction surgery 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.

 Best wishes for a helpful consultation

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.