Breast reduction from insurance? I’ve always had pretty bad back pain from my breasts and shoulder pain/dips.

Question

I have OHP and they can be very difficult with surgeries as it took almost a year for my son to get his tonsils removed. I’ve always had pretty bad back pain from my breasts and shoulder pain/dips in my shoulders. Ever since middle school I’ve had large breasts and it runs in my family, my mom even had a reduction. When I had a kid I started having bad back spasms. I’m currently a size 36 G/H but even those sizes don’t suffice. I’m wondering if it’s even worth bringing up?

James N. Romanelli, MD, FACS · Answer

Even though I'm not familiar with the specifics of Oregon's health plan, most health insurance companies cover some or all of the costs of breast reduction surgery if it's deemed "medically necessary." Based on the symptoms you describe, it's likely that your procedure would fall into that category. I recommend seeing your primary care physician, if you haven't already done so, to document your symptoms. Then choose a board-certified plastic surgeon to perform the breast reduction.Best of Luck
  
Dr. Romanelli

Scott C. Lindsay, DO · Answer

Hi! First I would suggest you seek a consult with a board certified plastic surgeon who participates with your insurance. The surgeon can prepare a packet of information to be sent to your insurance company for authorization. Each insurance company has different criteria that must be met and if you happen to meet your insurance's criteria the procedure may be covered. It is worth a shot to check! Good luck to you!

Rafi S. Bidros, MD, FACS · Answer

Thank you for your question. I am unfamiliar with OHP, however it will depend on your insurance plan and policy. Many insurance providers like to see that you've attempted 3 months of conservative treatment and this would need to be document by a physician. Your height, weigh, BSA and history of symptoms will be evaluated to determine eligibility. As always, consults with a Board Certified Plastic Surgeon.  They will be able to verify your insurance benefits and give you answers specific to your situation. Alternatively, if OHP does not cover the Breast Reduction, you may want to consider having a cosmetic Breast Reduction to relieve your discomfort.  Financing options are available if you need assistance. Best of luck!

Michael F. Bohley, MD · Answer

In the past, Oregon Health Plan (OHP) has not covered breast reduction surgery. It has been considered a 'below the line' procedure, which is unfortunate. The benefits of breast reduction are many, and have been substantiated in multiple clinical studies. My hope is that this will become a covered benefit in the future as health care reform efforts continue.

Breast reduction from insurance? I’ve always had pretty bad back pain from my breasts and shoulder pain/dips.

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Answer: Breast Reduction Coverage?

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Breast reduction from insurance? I’ve always had pretty bad back pain from my breasts and shoulder pain/dips.

Answers (4)

Answer: Breast Reduction Coverage?

Answer: Breast Reduction Coverage?

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Everything you need to know about Breast Reduction

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