How to Convince Insurance to Cover Breast Reduction?

They look as several factors when they try to decide if the patient will be covered under the health insurance coverage for breast reduction. They look at your symptoms in addition to your height and weight, breast size and the amount to be removed. They have a formula that is based on your height and weight and that will determine how much they will want to have removed in order to cover the surgery.
I have had good success getting breast reduction covered by the patient health insurance benefits.
Good luck.

Hello and thank you for your question.
It is not a matter of convincing your Insurance company, but meeting the requirements to have it approved. Schedule a consultation with a board certified plastic surgeon to discuss your options. The office will help you through the insurance process. Best wishes!

You will find that coverage of the procedure varies widely from one insurance policy to the next. Many insurance companies will cover if you have 500 grams of excess breast tissue (about 1 lb) per side and rarely some may cover as low as 350 grams. However some companies may require a kilo or more depending on your height and weight.  This being said, before you go forward with surgical procedures you may want to see your primary care physician to see if they have any other recommendations and such as therapy or medications. Many neck and back pain symptoms can be treated very successfully with strengthening of the spinal supporting musculature and this may be required by your insurance company.  This requires some time and effort but may provide a lifetime of benefit.  

Insurance companies frequently want to see a record of having been treated by nonsurgical methods for at least six months and not getting improvement with conservative treatments.  This usually means that you have tried diet and exercise, medications and possibly therapy or chiropractic and have not gotten adequate relief.  The next thing to do is get an exam with a board certified plastic surgeon with a good reputation. He should be able to perform an exam to tell exactly how much excess breast tissue you have.  Then the surgeon will write a letter to the insurance company and see if they will give approval for the surgery. The insurance company will send both you and your provider a letter with their decision within a few weeks in most cases.  Many patients are able to get insurance coverage for the procedure, but if you do not qualify many places offer a significant reduction in the price for out of pocket cases that are paid in advance.  Best of luck on your journey