Breast Reduction Covered by Insurance?

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions. This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive

It sounds like you meet the criteria for breast reduction surgery. Contact your insurance company and see if it is a covered procedure under your policy. Some companies have it excluded no matter what your symptoms are. If it is a covered procedure, see a Board Certified Plastic Surgeon for a consultation. Your surgeons office will be able to submit to your insurance on your behalf to obtain pre-authorization. If the insurance company denies it, ask the office to file an appeal for you, many times the insurance company will reverse their decision. Good luck!

If your primary care physician provides documentation and treatment of your symptoms arising from you breast hypertrophy, you should be able to have insurance pay for breast reduction surgery. Your growth in both stature and breast size should be stable. You could then be evaluated by a plastic surgeon for surgical treatment. Your surgeon will go over the pros and cons of having breast reduction surgery at a young age.

Reducing the size and weight of the breasts will make a huge difference in your back and arm pain. Exercise will become easier and much more enjoyable!
Thanks for your question. Best wishes!

 

Gregory C. Park, M.D.