Will UnitedHealthcare Choice cover my breast reduction?

I am 5'6 140 lbs with uneven breasts. The left breast is a size D and the right breast is a size DD and I have a bandwidth of 34 inches. I get headaches 4 days a week, I can never find a supportive bra, my bra straps cause significant pain and the center of my back kills me if i am active or standing for long periods of time. The right breast is getting significantly lower and heavier as time goes on. I want to get them reduced to a C. I just need to see if my insurance will cover it and i am qualified.

Doctor Answers 3

Willl United heath care cover my breast reduction?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question and this is a common question and a problem since insurance companies are making it more difficult to approve surgeries.  I think you are a good candidate for the surgery but you will need to see a board certified plastic surgeon who can help you through this process.  It will require that you try conservative therapy first and with good documentation and patience you may be able to get approval.  You may want to talk to your insurance company first to see what they will cover and what it will take to get it approved.

La Jolla Plastic Surgeon
4.7 out of 5 stars 14 reviews

Insurance coverage

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Every insurance plan has their own unique criteria on whether they will
cover a breast reduction. More and more, we are seeing plans where a
breast reduction is not a covered benefit. If it is a covered benefit,
some insurance plans set a minimum required amount of tissue to be
remove in order to met their threshold for coverage. Some set the amount
in relation to your BMI (height and weight). Others require extensive
medical records documenting neck pain, back pain, and history of rashes.
The other alternative is to opt for a breast reduction as a self-pay
option. Start by visiting with a board certified plastic surgeon to
learn more about your options.
Best wishes, Dr. Basu
Houston, TX

Insurance may cover reduction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thanks for your question. I'm sorry that you are having this problem. Insurance companies have been denying a lot of reductions which is very unfortunate for people like you. A chronicled history from your primary care physician, physical therapist, chiropractor, OB-Gyn, etc. can help establish a case for your reduction. Upon exam an estimate can be made as to how much will be resected. All of the above along with photos can then be sent in to try and establish medical necessity. The frustrating part is that patients like yourself almost ALWAYS benefit from the procedure regardless of whether it is deemed "necessary" or not by the insurance company. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.8 out of 5 stars 92 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.