Should I Get a Breast Reduction if my Copay and Deductible is High?

I've had consultation August 2012 and my PS said that my breast reduction will be covered 100%. My surgery is scheduled Tuesday Jan 8. Yes in 2 days. I have been waiting 5 months for this life changing event. I am 5'5 160 pounds 34E. The PS called me Friday telling me that my deductible is $13,500 and after my surgery I will be responsible to pay that amount. that is a large lump sum of money. Should I still go get it done? I'm so confused!

Doctor Answers 9

Breast Reduction and Insurance Company Financing?

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What a stressful piece of information to receive two days before your planned breast reduction procedure!  I am sure that you will be able to have the procedure performed for much less,  even without health insurance involvement.

 Obviously, your plastic surgeon's office will be in a better position to provide you with alternative financing options

Don't give up on having the breast reduction procedure however; this procedure tends to be one of the most patient pleasing operations we perform.

Breast reductiion deductible

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$13,500 is an enormous deductible; even in NYC, I have never seen one this high. Your insurance company determines whether the procedure is covered; if so, you should have received a written copy of the preauthorization document. I suspect that $13,500 is the cost of the procedure and facility. Call your insurance and ask if it has been authorized and, if so, confirm the applicable deductible. If this is inconsistent with what you were told, then you need a new plastic surgeon.

Huge deductible for a breast reduction

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That is certainly a huge deductible.  That is the problem with insurance, it seems good until you have to use it, since only 7% of the population in the US uses their insurance in a given year 93% think that they have good coverage.  If this is true then you may want to consider going to a plastic surgeon who can perform this as an elective cosmetic breast reduction and not involve your insurance company at all.  It sounds like you have only catastrophic care only.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast reduction and deductible

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Welcome to Obama care 2013!  It is up to you to decide if you want to have your reduction now, and to pay for the surgery.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast Reduction With High Deductible

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As with all surgery, you must weigh the benefits/risks and costs.  In my community, the total cost out-of-pocket would certainly be less than your deductible.  Your other option is to wait until you have a better ins. policy.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Breast Reduction and High Insurance Deductable

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I'm sorry to hear that this issue may interfere with your planned breast reduction. Insurance companies call the shots and the financial part of the procedure can be confusing to everyone involved. While each persons deductibles need to be considered for the whole year and as part of how much you anticipate spending on health care this year, it may be a good idea to follow Dr Culbertson's advice below and ask to have it done as an aesthetic surgery package. In our practice, the total cost would be much less than the deductible. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 74 reviews

High deductible for breast reduction

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Having a breast reduction is a life-changing event, and most women who have the procedure, don't regret it.  (In fact, most of my patients wonder why they waited so long!)  That said, I understand the financial burden that a high out-of-pocket payment can be.  I would suggest that you check with your insurance company and confirm that this is really what your out-of-pocket expense would be.  If it is, then definitely consider doing the surgery as cosmetic.  Most plastic surgeons do offer a package price (including surgeon's fee, operating room, anesthesia costs, post-op bra, etc) for cosmetic surgeries that may be considerably less.  Good luck!

Anureet K. Bajaj, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 21 reviews

WOW!!! Now thats a deductible??

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 WOW!!! Now thats a deductible?? Please, if you have to pay that much out of pocket consider having your Breast Reduction done as a Cosmetic Procedure/ Surgery. Our office offers package pricing of approximately $6,800 and up for Breast Reductions. This includes your Anesthesia, Lab, Pathology, Surgeon & Facility Fees. It does not the cost of prescriptions which usually run about $250.
 Many ASAPS members offer such package pricing for Aesthetic Surgery. Consider a consult with a ASAPS member in your area for a Breast Reduction. You probably would save a significant amount of money. Best,


Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon

Deductible of $13,500 for Insurance Covered Breast Reduction

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         I have never heard of a deductible that high, but insurance tries to cover these procedures less and less.  You can always call the insurance company to determine if they made a mistake.

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.