Breast Reduction Insurance Coverage for Patients Below 18?

Thank you for your question.
You need to reach out to your insurance company for your answer. Find out if this is a covered benefit and what requirements need to be met. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

Your best option is to seek the evaluation of a board certified plastic surgeon and have them prepare a letter of predetermination of benefits letter to your insurance carrier to ascertain coverage. This will best answer your question whcih in my opinion should be covered.

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

Reductions can be done as early as 15 with parental consent, a proper medical clearance and breast growth that has stopped. Insurance coverage is a hit or miss depending on the carrier.  Usually having symptoms related to breast size is necessary for insurance coverage. Getting it covered though is very difficult. Insurance companies wont tell anyone how much tissue needs to be removed to qualify for coverage. Then if the surgeon is 1gram off they deny coverage after the fact. Insurance companies make money by denying coverage. For that reason most plastic surgeon will likely ask for payment up front.  Breast reductions are the most gratifying operations because years of neck, back and shoulder pain are gone within days.  The final size result depends on your starting size. If you start larger then you will likely end larger. It is not possible to choose a size with any real accuracy. The main reason is that the procedure removes breast tissue but leaves enough tissue to preserve the blood supply to the nipple and areola. Thus more tissue needs to be left behind to ensure nipple viability. The nipple and areola is constantly being accessed during the operation. See a board certified plastic surgeon for specifics on your treatment.

It is certainly possible that a teenager would be a candidate for a breast reduction. If the breast are excessively large and disproportionate to your body size and are causing neck back and shoulder pain.  All insurance plans are different about qualifying for coverage.