Will Insurance Cover Breast Reduction for H Cup Breasts?

Question

I have been suffering for years with back, neck, and shoulder pain due to the size of my breasts but never got surgery due to lack of insurance and I wanted to have a child first.Now, I have had my child which has caused my breast to be even larger now they are a size 42 H. I have medicaid but it is the blue card(non traditional medicaid), what would I have to do to get Breast reduction covered?

Scott C. Lindsay, DO · Answer

Hello and thank you for your question.
First thing to do is call your insurance company to find out if this is a covered benefit under your policy.
Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

Otto Joseph Placik, MD · Answer

You may want to read my answer here so that I avoid being repetitive:
http://www.realself.com/question/breast-reduction-insurance-coverage
In most instances with private insurance, your doctor can submit a letter of predetermination of benefits to ascertain if your procedure is covered. However, Medicaid does not accept or review these letters so that is a moot point. In general, its sounds as if the amount of reduction would be reasonably covered in your particular situation.

C. Bob Basu, MD, MPH, FACS · Answer

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

Tom J. Pousti, MD · Answer

Based on your description you may be a good candidate for breast reduction surgery; for  physical and emotional reasons.
	The best way to obtain insurance coverage for breast reduction surgery involves some &ldquo;hoops&rdquo; 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 &ldquo;authorization&rdquo; for the procedure.
	This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.
	Best wishes.

Steven Wallach, MD · Answer

Insurance does not always cover a breast reduction. The best thing for you to do would be to call yoru insurance company and ask for their criteria to approve them. Then seek a doctor that will accept Medicaid.

Will Insurance Cover Breast Reduction for H Cup Breasts?

Answers (8)