Can my breast reduction be covered by Obama care?

Im 5'0 and 140 pounds and i wear a DDD in bra size. I have had back problems all my life and the top of back is starting to arch and ache every day. I try to keep my poster correct but its hard because of the weight of my chest. I don't wear real bras only sports bras because i hate that my boobs look to big for my size. I have insurance under obama care how can i get my reduction covered by my insurance?

Doctor Answers 4

Can my breast reduction be covered by Obama care?

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Thank you for the question and congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. Based on your description, it sounds like you may be an excellent candidate for the procedure.  

Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, 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. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.

This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. 

Also, prepare to be persistent when dealing with health insurance companies. I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.

Insurance Coverage for Breast Reduction

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Your best bet would be to contact Plastic Surgeons in your area so that their office staff can assist you in determining what criteria your particular insurance policy uses to determine your eligibility for this procedure.  Some policies specifically exclude coverage for breast reduction surgery. You can do this for yourself online but it is usually much easier to get help from offices that do this frequently and are familiar with the process. Physically, you appear to be a good candidate for this surgery although this does not necessarily mean that your insurance carrier will cover this procedure for you. 

Robert C. Bledsoe, Jr., MD
Grapevine Plastic Surgeon

Breast reduction covered by Obama care?

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Thank you for your question and you seem to be a candidate for a reduction. To determine if you are covered by your policy you will need to check with your insurance carrier.  Depending on what plan you have will determine if you are covered and what your deductible will be.  I would start with contacting the local plastic surgeons in your area and have two or three consults to see what can be done for you.

John D. Smoot, MD
La Jolla Plastic Surgeon
4.7 out of 5 stars 14 reviews

Insurance Covered Breast Reduction

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Obama care or not, having a breast reduction covered by insurance depends on your particular policy.  Some insurance companies have begun listing breast reduction as an exclusion.  That means, no matter what your symptoms or complaints, it will never be covered under that particular plan.  You can frequently find this out by bringing up information on your policy online.  If it is potentially covered, you will find some basic criteria that must be met.  Then, you have to find a plastic surgeon who takes your plan and does insurance-covered breast reduction.  That plastic surgeon has to take measurements of your breast and submit a letter to try to get pre-authorization for the procedure.  That effort can take 6 weeks or more.  If you qualify and get approved, then you can move forward to schedule and have your surgery.  The surgery will still not be free of course.  If you have a high deductible/out-of-pocket, you may be paying quite a bit for the surgery whether it is done through insurance or not.  So, arm yourself with information and do your research.  See a plastic surgeon for a consultation.  Good luck to you!

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.