Will Blue Care Pay for my Breast Reduction?

Question

I am 20 years old, my weight is 240 and my height is 5'6. I wear a size 40H in bras. Will blue care insurance cover my reduction?

Moneer Jaibaji, MD · Answer

Thank you for the question. This is a common question. If you have insurance and you are symptomatic; i.e. have neck, back and shoulder pain and you have documentation by your primary care physician, then I think you should try the insurance route. The plastic surgeon will submit all the information along with his examination findings. The insurance may approve the surgery or reject it. If the surgery was denied they will tell why it was denied.

	If you decide to pay for it, then you have to find a board certified plastic surgeon, this can be from the American Society of Plastic Surgery directory. Get a consultation, look at before and after photos and determine what you want.

C. Bob Basu, MD, MPH, FACS · Answer

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

Tom J. Pousti, MD · Answer

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. It will be in your best interest to achieve a long-term stable weight prior to undergoing the breast surgery. Doing so will decrease the chances of complications associated with the surgery and minimize the chances that further surgery will be necessary in the future.

	The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. 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. This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.  

	Prepare to be persistent and remember that breast reduction surgery is one of the most patient pleasing operations we perform.
	Best wishes.

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