Paying for breast reduction in Alberta?

Question

If I was to pay for my breast reduction surgery, would I be able to claim it through Alberta Health-care for some, if not all, to be reimbursed. I am having trouble having my surgery due to the fact that a lot of doctors do not deal with surgeries through Alberta Health-care and the ones that do have long waiting lists.

Trevor Brooks, MD · Answer

Thanks for your question. It is true that many surgeons have stopped doing covered breast reductions in Alberta. In my practice, I never do partially covered reductions, as the government may consider this "double dipping" by getting paid in both the public and private system for the same procedure. If the goal of the procedure is to reduce the size of the breasts for functional reasons (pain in the neck and back, shoulder grooving from heavy breasts, intertrigo (rashes) etc.), then it should be considered a covered procedure. There is not a weight cutoff to be considered for breast reduction as there is in other provinces, and as such it falls to the discretion of the surgeon whether is will be a reduction (covered), or a lift (private pay). As all reductions do come with a component of a lift the area becomes even more grey, and some surgeons opt to consider all breast surgeries as lifts. This is great for the people that can afford it as they can get treatment much quicker, but it increases the load on the remaining surgeons who still do covered procedures (as you have seen with the increased wait times). The other thing that can be considered is if you have a really good insurance provider, then you may be able to be reimbursed for a portion or all of the procedural costs. This is not possible with most insurance providers, but you can check with them to see if your specific plan has that option. And as a final note, make sure you see a board certified plastic surgeon who has experience with this type of procedure to give yourself the best chance of having a positive experience and good results.

Sugene Kim, MD, FACS · Answer

Breast reduction may or may not be covered depending on your insurance 
carrier and your breast size. Please check your insurance policy to see 
whether breast reduction is a covered procedure. Often times, insurance 
company will dictate how much breast tissue to be removed. Please visit 
an experiences, board-certified plastic surgeon to learn about the 
procedure, its cons and pros, benefits, and alternatives. Please contact
 your insurance carrier to learn about inclusion and exclusion criteria.
 Best wishes.

Paying for breast reduction in Alberta?

Answers (2)

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