Will Aetna Insurance Cover my Breast Reduction?

Unfortunately, each insurance company has their own criteria. 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 neck pain, back or shoulder pain, hygiene difficulty, and breast pain. 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.This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive. 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

Your policy is likely to cover your breast reduction surgery, but Aetna has many different policies so coverage varies greatly.  See your surgeon to discuss your best options.

It is very possible you are a candidate for surgery, but all insurance companies have their own requirements, and each company has different policies where some have specific exclusions. You could call your insurance company and ask if your policy covers the surgery or see a Board Certified Plastic Surgeon who is well versed in all the ins and outs of obtaining pre-authorization. Good luck!

Based upon your description, it sounds like you would be an excellent candidate for breast reduction.  Aetna has specific criteria that need to be met to obtain insurance coverage, based upon your symptoms (back pain, rashes, etc.), how long you have had them, failure of non-surgical treatment and the amount of breast tissue to be removed (based upon your current size and surgical goal).  Aetna's clinical policy bulletin, which explains their exact requirements, is available on their website.  Go to Aetna.com and search for "clinical policy bulletin breast reduction".

I would recommend consultations with board-certified plastic surgeons experienced in breast reduction, who can review the procedure with you including the potential risks and benefits, as well as help you with the process of trying to obtain insurance coverage. 

Good luck.

Different companies and different policies have restrictions for breast reduction. A visit to the plastic surgeon's office will help clarify the situation.