Will my BCBS PPO Alabama insurance cover a breast reduction?

I am a 22. I am 5'9 and weigh about 220-230. I have size 40 G breasts. It is hard for me to wear bras with underwire because my breast are so heavy they dig into my ribs and pull on my shoulders. I get indention in them and usually bruising on my ribs. My back is always hurting. I usually have wear sports bras just so I can be wearing something. I've tried all type of different bras, nothing works. They are so heavy, sometimes I will hold them up when I'm sitting. Please help me, I need relief.

Doctor Answers 2

Yes, but...

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BSBS of AL does cover breast reductions assuming you meet their criteria.  You can call your insurance carrier and ask them to provide you an explanation of what they require for breast reduction.  Don't accept the answer that "if it is medically necessary we will cover it".  Ask for their specific criteria so that you can determine if they may consider it for you.  They can probably refer you to a link on their website that discusses that subject.The plastic surgeons in our area also know how to interact with BCBS to request a determination.  Any plastic surgeon in those areas should be able to help assuming they are part of the BCBS PPO network.Good Luck

Pensacola Plastic Surgeon
4.9 out of 5 stars 10 reviews

BR and Insurance

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Under certain circumstances Breast Reduction is covered by insurance. 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

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.