Will my meridian pay for my breast reduction?

Question

Larry S. Nichter, MD, MS, FACS · Answer

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

Nelson Castillo, MD · Answer

Thank you for your question. The short answer is, it depends. Insurance companies typically will require 3-6 months worth of documentation from your primary care provider of breast-related symptoms (rashes, neck/back pain, and shoulder grooving), and treatment failures (weight loss, physical therapy), that have led you to pursue surgery. Once approved, the insurance companies will determine either a fixed amount of breast tissue, or an amount proportional to a patient’s height, that needs to be removed in order to have the operation covered by insurance. It would be best to contact your insurance carrier to see what are their criteria for coverage, as well as a board certified plastic surgeon to discuss your options for surgery. Best of luck!

Tom J. Pousti, MD · Answer

Thank you for the question.  Generally speaking, breast reduction surgery is one of the most patient pleasing operations we perform. By removing “excess” breast tissue, adipose tissue, and breast skin  this operation reduces AND lifts the breasts to a higher position on the chest wall (in other words, the breasts are "automatically" lifted when a breast reduction is performed). By doing so, patients often find improvement in neck, back, and shoulder discomfort and find it easier to form their activities of daily living and exercise.
 Obtaining insurance coverage for breast reduction surgery will likely involve 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 letters/pictures from your plastic surgeon will help you obtain authorization.  Prepare to be persistent when dealing with health insurance companies.
When the time is right,  seek consultation with well-trained/experienced board-certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.
I hope this, and the attached link, helps.  Best wishes as you work towards your goals.

Sheila S. Nazarian, MD · Answer

When you go to see your plastic surgeon, they will submit a claim to your insurance to get a pre-approval.

Stephen M. Davis, MD, FACS · Answer

Each insurance company have developed their own criteria for breast reduction. Some require a specific BMI, some require a minimum volume of breast removal, some require breast removal based on BMI, etc, etc, etc.Seek out a Board Certified Plastic Surgeon who knows you companies requirements, they can then help you understand if it should be covered. Good LuckStephen M. Davis, MD, FACSGreen Hills Plastic SurgeryNashville, Tennessee

Will my meridian pay for my breast reduction?

Answers (5)

Answer: Insurance

Answer: Insurance

Answer: Will my meridian pay for my breast reduction?

Answer: Will my meridian pay for my breast reduction?

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Everything you need to know about Breast Reduction

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Will my meridian pay for my breast reduction?

Answers (5)

Answer: Insurance

Answer: Insurance

Answer: Will my meridian pay for my breast reduction?

Answer: Will my meridian pay for my breast reduction?

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.