Do I qualify for breast reduction surgery? Ins provider United Healthcare (Photos)

Hello! I am 21 years old, 103 pounds, and I am hoping for a breast reduction. I have been desperate for this procedure for several years due to many inhibitions such as scoliosis, daily tension headaches that pull tightly on the back of my neck, inability to exercise, self consciousness, back and shoulder pain, etc. Unfortunately over the years the expense has always been a major setback in foregoing treatment for this. Please let me know of any options available. I'd appreciate it greatly!

Doctor Answers 5

Am I a Good Candidate for Breast Reduction Surgery?

You do have what appears to be a small frame and could benefit from #breast reduction. During this procedure your surgeon can also perform a lift. The combination of these two procedures should help you achieve the appearance you are looking for. The reduction would not only reduce the size of your breasts but also correct any asymmetry (one breast larger than the other). Your surgeon can evaluate your current breast shape and volume of tissue, and include a lift to give you smaller yet full and "perky" breasts. By including a #lift with the procedure, you can also assure correct nipple placement and appropriate areolar size. 
Insurance companies have a number of requirements and a Board Certified #Plastic Surgeon will be able to determine if you are a candidate for reduction. Pre-authorization by an insurance company is required prior to surgery, and the process takes approximately one month. Your plastic surgeon who can contact your insurance company for authorization following a #breast examination to document of your symptoms. You should also consider seeing your primary physician for an examination and documentation as well. 

Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

Breast Reduction - Insurance Coverage

Thank you for your question! It will depend on your insurance plan and policy. Many insurance providers like to see that you've attempted 3 months of conservative treatment and this would need to be document by a physician. Your height, weigh, BSA and history of symptoms will be evaluated to determine eligibility. As always, consults with a Board Certified Plastic Surgeon once you're ready to start the insurance process.  They will be able to verify your insurance benefits and give you answers specific to your situation. Best of luck.

Rafi S. Bidros, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 24 reviews

Breast Reduction Qualifications

Insurance companies have historically made it a challenge to get breast reductions covered. The main issue is related to having symptoms from the heavy weight of the breasts. Clearly, your history indicates that you are having symptoms and your pictures are very constant with this as well. So, your best option at this point is to find a board certified plastic surgeon who is on your insurance plan that does breast reduction surgery. Also, check to see if breast reduction is as covered benefit. Some insurance plans exclude breast reductions. Most insurance plans will want to see that you have failed medical management and how much weight of breast tissue that will be removed before authorizing the surgery. I hope you get approved and you should have a great outcome.

Jeffrey W. Hall, MD
Austin Plastic Surgeon
4.5 out of 5 stars 15 reviews

Breast reduction qualification

Based on your photos you may qualify for breast reduction coverage under insurance. Recommend an evaluation by a board certified plastic surgeon.Best, Dr. Yegiyants

Sara Yegiyants, MD, FACS
Santa Barbara Plastic Surgeon
5.0 out of 5 stars 6 reviews

Insurance coverage for breast reduction

Coverage is insurance specific and varies. Meeting with a plastic surgeon will be the best way to know a more definitive answer as it depends on many different variables including your height and weight, estimated weight of tissue to be removed, and associated symptoms.  It can also be helpful to bring any documentation you have of other treatments you have sought out for your complaints. Good luck!

Neil Fine, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 1 review

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.