Breast Reduction Size for Insurance to Cover Surgery?

It is no longer determined by the 500 gram rule. It all depends on your height and weight which is plugged into a equation which gives BSA (body surface area). This gives a number which determines how much breast tissue is required to be removed for insurance to cover it. It depends now on your height and weight. The heavier your are, the more breast tissue they want removed in order for the surgery to be covered.
What will happen at your doctors office is that photos will be taken and your surgeon will submit all this information along with the symptoms you are having to the insurance company, which will them determine if it is medically necessary.
Good luck.

Hello and thank you for your question.
Every insurance company is different. Reach out to your carrier and find out what your benefits are and the criteria needed for breast reduction surgery to be covered. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

Insurance coverage of breast reduction is contingent on establishing a case for medical necessity. Patients will typically have documented evidence of neck/back and shoulder pain as well as rashes and bra strap grooving attributable to the increased breast weight. They will often demonstrate that these symptoms have been resistant to more conservative measures like therapy, weight loss and pharmacologic intervention.The requirements for reduction will vary from one insurance provider to the next. This may be a standard "500 gm per side" stipulation or a more customizable standard based upon body surface area/Schnur scale.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

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

Thank you for your question.  This is a very common and tricky question in that every insurance company has set forth their own specific parameters that must be met to deem a procedure 'medically necessary.'  In the case of breast reduction coverage, most insurance companies (but not all) require that a minimum of 500g of breast tissue be removed from each side.  They generally also require a long documented history of neck, shoulder, and/or back pain, and numerous letters and office note documentation from primary care physicians, chiropractors, orthopedists, dermatologists, and physical therapists attesting to the extent of physical hindrance of a patients large breasts and all failed methods of control (different bra's, physical therapy, medication use for rashes in the inframammary fold, etc...).  This is a lengthy process that typically requires an authorization process (and often an appeals process), but unfortunately most of the process is outside the control of the plastic surgeon.  If you are interested in having a breast reduction procedure and you believe as though you have a substantial case to warrant medical coverage, the first step is to call your insurance to see what their conditions for determining medical necessity are.  Then you should consult with a board-certified plastic surgeon who is well-experienced with breast reduction procedures.  Photos will be taken along with a thorough history documenting your symptoms and a claim can be made to your insurance company.  I hope you find this helpful and best of luck!

It all depends on your insurance provider and your measurements, specifically weight and height. Based on that information, your provider will then tell you how much of a reduction is necessary.