How To Best Get Coverage For Reduction of 34H Breasts?

im 140 pounds 5'3 an 34H,one of my legs is 1/2inch shorter then the other making having large breast more uncomfortable! my family doctor is refusing to help me in the process of getting a breast reduction saying if i work out my back more I will be fine. Im not sure what steps i should take to get this procedure done. I only have blue cross through the welfare program so im limited to what doctors are available and my insurance is super strict! I need help! Im open to all advice, thank you

Doctor Answers 8

Breast Reduction

I am sorry you are suffering.  You are of slim build, and H cup breasts would cause a skeletal imbalance affecting your posture and contributing to back discomfort.  I would contact a board certified plastic surgeon directly.  All the best, "Dr. Joe" Gryskiewicz

Minneapolis Plastic Surgeon
5.0 out of 5 stars 276 reviews

Breast reduction-Medicaid coverage

Unfortunately, it is not uncommon for family doctors to interject themselves into the breast reduction process and make it difficult for the patient. Honestly, I think that, in the current regulatory environment, they think that the $ will come out of their own pockets. However, that said, here is what you need to do: call the insurance company and ascertain whether you must be referred to a plastic surgeon through the internist. If so, tell the insurer that your internist refuses to make a referral and then tell them your bra size. Request reassignment to a new internist and referral to the plastic surgeon. The surgeon is responsible for pre certification of the procedure. Best of luck!

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

You will probably get insurance coverage for breast reduction.

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
4.8 out of 5 stars 9 reviews

Getting Insurance Coverage for Breast Reduction Surgery

Your family doctor probably isn't familiar with the process to get insurance coverage for breast reduction. It is usually done by the plastic surgeon's office. I would suggest that you contact your insurance company to find a Board Certified Plastic Surgeon that is under their plan and have their office help you get pre authorization for your surgery. Good luck.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 76 reviews

Coverage for Breast Reduction

You may need to start off with a new primary care doctor. However, if you have medical insurance through welfare, you may have a problem finding a surgeon since in some states, the welfare programs haev not been paying surgeons for their services.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 68 reviews

Breast Reduction

I feel badly when I hear of a patient with breast hypertrophy being told they need to work out or lose weight and all their problems will disapppear. It shows a true lack of understanding the problem and makes me worry what else the individual fails to understand. Many insurances in our area require the primary care doctor to verify the patient's need for a reduction, so step one for you may be finding a primary care doctor that is understanding. Then you need to contact your insurance carrier to see which plastic surgeons take payment from them, then see one of the surgeons. However, you need to be aware that some minimal coverage carriers exclude breast reduction from coverage and yours may be one of those.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Insurance and Breast reduction

You should seek consultation with a plastic surgery to be evaluated first, and then he/she can help advise how to go about seeking approval.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Reduction Candidate?

Thank you for the question.

Frankly, your family practitioner advice is somewhat ignorant;  you may want to consider changing physicians.

One way or another you will need to make your way to offices of well experienced board-certified plastic surgeons to get the process started. You will find that in order to obtain insurance coverage for breast reduction surgery  you will have to “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.

Be prepared to be persistent.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

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.