Breast Reduction and Lift Insurance Coverage Requirements?

Breast reduction: insurance coverage for youLarge 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.#breastreduction#insurance

Thank you for your question.
Reach out to your health insurance company. Find out your benefits and the requirements for breast reduction surgery. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

Breast reduction, or reduction mammaplasty patients are among the most satisfied of all plastic surgery patients. Large breasts (macromastia) can often decrease quality of life for a woman. With breast reduction, you can have smaller breasts that sit higher on your chest wall. You will also find relief in your neck and back with the decrease in weight and more ergonomic position of your breasts.There are several different variations of breast reduction, differing by size, and amount of incisions; procedure; and the results. The different types of reduction techniques include: The wise pattern breast lift, the anchor shaped incision, and the donut mastopexy.1. The wise pattern breast lift involves an anchor-shaped incision around the natural contour of the breast. To most patients surprise, this scar is mostly hidden under the inferior aspect of the breast. However, the scar around the nipple/areola is visible. Most patients heal this anchor type scar very well and are satisfied with smaller areola in exchange for the scars. This surgery is used when there is a lot of excess skin that needs to be removed in order to lift the breast and give it a more aesthetic shape.2. Often times, the anchor shaped incision can me diminished to create a lollipop or J shaped incision. This results in some excess skin at the inferior aspect of the breast near the breast crease that will flatten out over a 6 month period. Some patients are willing to tolerate this excess skin for 6 months in exchange for a smaller scar. This is a personal decision that each patient can make.3. The donut mastopexy involves creating an incision around the areola and removing a doughnut-shaped area of skin. This surgery can be used for patients that need a smaller amount of lifting. This surgery results in a scrunched-up look to the breast skin surrounding the areola for about 6 months before it flattens out. Patients need to be understanding and tolerant of this in exchange for an areola-only scar. These patients do run the risk of areola widening as well.Insurance may cover some of these cases when back pain, shoulder bra-notching, and rashes under the breast are present. Insurances vary though and your doctor can submit a report and photos to see if your insurance approves your procedure.The ideal size depends on the size of your hips and waist. Your surgeon will be able to guide you in this decision.The risks of the procedure include bleeding, infection, bruising, poor scarring, pain, swelling, and changes to nipple and areola sensation, and rarely, partial or total nipple loss. The recovery time is usually a couple weeks if all goes well. In general, however, breast reduction patients are some of the most satisfied and grateful plastic surgery patients. This is truly a life-changing procedure. In my area, the cost ranges from 6700-8500. Best of luck!

 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. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses

         Breast reduction
surgery is often covered by insurance carriers, but breast lift is never
covered by these companies. Some insurance companies actually exclude breast
reduction as a contract exclusion. When insurance carriers cover breast
reduction, they may have specific criteria that must be met. For instance, most
insurance carriers require documentation of symptoms. Examples would include
back pain, shoulder pain, breast pain and headaches to name a few. They may
also require documentation of attempted non surgical management of symptoms.
Examples might include physical therapy, support devices and anti-inflammatory
drugs. Some insurance carriers require a minimal amount of breast tissue removal
from each breast. This is often based on calculations, which utilize the
patient’s weight and height.

 

         The process starts
with a consultation. At that time, pictures are taken and a prior authorization
letter is sent for approval. It typically takes about six weeks to obtain a
response. If your insurance carrier’s criteria are met, you are ready to
schedule surgery. Blue cross blue shields criteria varies from state to state,
but in most states, it has a high approval rate. 

You will likely benefit greatly from a lift and reduction.  The insurance portion only applies to the reduction, but usually a lift is an important part of the procedure to obtain the best looking results.

Most insurance companies look at the BSA. This is the body surface area which is a ratio of your weight and height. This is obviously besides your complaints of neck pain, back pain and shoulder grooving. When calculating the BSA you will be give a number like 1.4 or something. This is take and looked at on a sliding scale to determine how much breast tissue needs to be removed per side in grams. If this is the amount to be removed or more then insurance company will likely cover the procedure.
So, you need to go see a board certified plastic surgeon to go over things as well as take photos to send to the insurance company.

BCBS tends to use a sliding scale called the Schnur scale to determine eligibility for breast reduction covergae.
The ling for this is:
http://www.bcbst.com/MPManual/The_Schnur_Sliding_Scale_chart.htm
I agree with the other physician's here, that you should allow suffcient time for the post-lactional changes to stabilize.

Hi Shannon - A breast lift is part of a reduction, so this shouldn't be an issue if you get insurance clearance for the reduction. BCBS usually requires 500g of tissue to be removed if you're under 200lbs. Check with your plastic surgeon to see if you're a candidate for this and to make sure that you won't be left with extremely small breasts if 500g is removed.

Your insurance is likely able to cover your breast reduction, and you should just speak to surgeon you want to see if he or she takes your insurance. The other thing I would recommend is waiting 6 months after you are done with nursing before you undergo surgery, to make sure your glands have time to normalize after breast feeding back to their usual size. Any additional sagging that happens at that time can be addressed at the time of surgery. The reduction is both a reduction and a lift at the same time. You will be back to feeling great in no time.
-Dr. David Mattos, New York Plastic Surgical Group