Will Affinity Health Insurance Pay for my Breast Reduction?

Im 20 years old 5'6 200 pounds I wear 44DDD I just recently gain weight but my breast has always been large I have a lot of back pains and my breast arey heavy

Doctor Answers 3

Breast Reduction - Insurance Coverage

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Each insurance company has its own criteria for whether or not a given procedure, such as a breast reduction, will be "covered."  At 5' 6" and 200 pounds, even with a bra size of 44DDD, my guess is that this will not be covered.  The company would be more likely to insist on weight loss or, at least, multiple documented attempts of conservative therapy, before agreeing to provide coverage.  That is just my guess, though.

The next issue, as always, is finding a board-certified plastic surgeon who participates in your insurance and/or is willing to accept what the insurance offers as "coverage" as payment for the surgery.  That has become increasingly challenging over the past few years.

The first step is to find a surgeon you're comfortable with and to try to obtain approval for the surgery.  I think it will be difficult based on what you say, but, as I indicated, each insurance policy has its own criteria.

I hope that this helps, and good luck,

Dr. E

Insurance coverage for breast reduction.

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H i,  I hope you find this article useful.  Good luck!

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1)  Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2)  Very big reductions (like from an F cup to a C cup) will usually be covered.

3)  Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4)  Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5)  DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6)  Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7)  Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8)  Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9)  Don't give up. If the first request is denied, demand an appeal.

10)  If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.


George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Breast Reduction and Insurance Coverage?

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Based on your description you may be a good candidate for breast reduction surgery; it may be in your best interests to drop weight first.

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.

This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.

Make sure you're saying a well-trained/experienced board-certified plastic surgeon.

Good luck!

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.