Does NC Medicaid cover a breast reduction? (Photo)

Question

I'm woundering because I only have is medicaid .I was told by a plastic surgery place that Medicaid wont cover,it,unless it was dealing with breast cancer .I have scoliosis and I'm a size DD .my scoliosis doctor recommended that I,get a breast reduction to,reduce,back,and neck pain.if medicaid does cover this procedure how can I get them to cover mine . thanks u for your time.

Kenneth Hughes, MD · Answer

NC Medicaid may require that you try "alternative treatments" such as weight loss and physical therapy first. If you have records from your family practice or internal medicine physician documenting your neck, back, and shoulder pain over the years, this will facilitate the Medicaid preauthorization process.  Typically insurance companies require 500 grams (3 cup sizes) reduction from each breast. 
Even if Medicaid funds the breast reduction surgery, many plastic surgeons are unable to cover the costs of the surgery with Medicaid's low reimbursement rates.  Some university settings with plastic surgery academic training programs may have a reduced fee available through a residency clinic.
Kenneth Hughes, MD, Board Certified Plastic Surgeon
Los Angeles, CA

Gary M. Horndeski, MD · Answer

Thank you for your question,               
The Bellesoma Method is a current technique to lift and/or reduce breasts without using implants or the ugly vertical scars.  The incisions are hidden around the areola and in the inframammary crease. The vertical incision has been completely eliminated. The areola incision heals almost invisibly due to the fact that there is hardly any tension on the closure. With this particular technique, ducts are preserved along with nerve supply maintaining nipple sensation and the ability to breast feed. Because the breast is reshaped internally and is secured to your chest muscles, upper pole fullness is possible without an implant. Attached is a patient who underwent The Bellesoma Method. Please note that her tissue was used to create upper pole fullness and cleavage without any foreign materials (mesh, implants, etc).  Unfortunately, we do not accept insurance for breast reductions.  Dr. Horndeski does not remove enough breast tissue to meet insurance criteria.  Instead, he utilizes the breast tissue to reshape the breast.  It is a proprietary technique that only surgeons that have been trained by me can perform. I hope this helps. 
Best wishes and kind regards, 
Dr. Gary Horndeski

Randal Haworth, MD, FACS · Answer

With today's insurance plans under the ACA, less and less insurance companies cover breast reduction surgery despite if you may have symptoms such as painful bra strap grooving, neck, shoulder and back pain overly large breasts. However, I suggest contacting your insurance company and asking exactly what is and isn't covered in regards to treating macromastia with a breast reduction. If  they do offer coverage then ask for a list of in network providers whom you can then contact to set up an appointment and consultation with to address your concerns.

Does NC Medicaid cover a breast reduction? (Photo)

Answers (3)

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.

Does NC Medicaid cover a breast reduction? (Photo)

Answers (3)

Browse related questions

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.