How big do your breasts have to be for insurance to cover a reduction?

Question

What's the specific amount of tissue that has to be removed? I am trying to get tricare to cover a reduction mammoplasty.. it’s been mentioned that a certain amount of breast tissues has to be removed for insurance to cover it.

James N. Romanelli, MD, FACS · Answer

As you mentioned, most insurance companies require a certain amount of breast tissue to be removed during a breast reduction for a patient to qualify for coverage. But that amount can vary depending on the insurer. The size of the breasts -- for example, a 44H -- isn't a factor. Insurance companies often use a formula called the Schnur scale when calculating the amount of breast tissue that needs removal. It involves comparing the amount of tissue removed to the patient’s body surface area (BSA). You should also discuss any physical symptoms, such as shoulder or neck pain, when consulting with a board-certified plastic surgeon because that can also help qualify for insurance coverage. 
Best of LuckDr. Romanelli

Jennifer Greer, MD · Answer

Thank you for your question! Insurance companies do have a specific amount of tissue they require to be removed in order to cover breast reduction, but it's unfortunately not straightforward:- Different insurance companies have different requirements- The requirement may differ based on your height and weight- The numbers aren't always easy to find.Your best best is to schedule a consultation with a board-certified Plastic surgeon who does a lot of breast reductions. She can submit to insurance for pre-approval and give you a better idea of whether she thinks you'll be covered. I've attached a link to a video where I explain this in a little more detail. Best of luck to you!

Susan Buenaventura, MD, FACS · Answer

There are no universal criteria for breast reduction; each individual insurance company has its own policies.  Symptoms of neck and shoulder and back pain, large heavy breasts would suggest medical necessity.  This does not mean insurance will cover it; it truly depends on the policy you have.  Some major insurance companies exclude breast reduction for coverage.  Don't let this deter you. Focus on your health and find a good board certified plastic surgeon who specializes in breast surgery.  It is a life changing surgery!

How big do your breasts have to be for insurance to cover a reduction?

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How big do your breasts have to be for insurance to cover a reduction?

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Our mission is to create a world where every investment in modern beauty is Worth It.