Breast Reduction & Insurance Coverage. What Are the Necessary Steps? (photo)

I'm 22 years old and I've always had bigger breast. I was a D/DD in middle school and was currently sized in at a 38H, but would like to go to a 38D cup. I have gained and lost and gained and lost and had my first child March of last year. It all has taken a toll on my breasts. Besides that, I have always had problems concerning them, incuding really bad self-esteem issues, back pain, deep shoulder grooves and main insurance provider is NJ Horizon Health. Necessary steps? Thank you.

Doctor Answers 2

Breast Reduction through Insurance

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Thank you for your question and photos.

Congratulations on your decision to proceed with breast reduction surgery.  It is one of the most patient pleasing operations we perform.

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.

Seek consultation with well experienced board-certified plastic surgeons. Ask to see lots of examples of their work. Prepare to be persistent when dealing with health insurance companies.  Keep in mind that  most patients are very pleased with the physical and “psychosocial” benefits of breast reduction surgery.


Best wishes.

Steps for insurance coverage of breast reduction

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Each insurance company has its own guidelines. Rather than asking plastic surgeons who practice in other parts of the country, I recommend that you access Horizon BCBS's website and read the criteria for yourself. They are subject to change at anytime. If I recall correctly, Horizon's criteria were particularly harsh in terms of the length of time patients had to document conservative medical management including physical therapy or chiropractic. Best of luck!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.