It may be helpful to understand the logistics of surgeons excepting insurance reimbursement for this procedure. As a general statement, patient who have symptoms of excessively large breast should have breast reduction surgery covered by insurance. If a surgeon chooses to accept insurance reimbursement, then that reimbursement comes with an understanding that the surgeon is not allowed to build a patient More than the insurance reimbursement amount. In other words, the surgeon will get paid only what insurance pace and no more and cannot charge the patient the difference. What insurance reimburses for breast reduction surgery in comparison to what most surgeons would charge as a cash procedure can be at tenfold difference. Insurance reimbursement may give the surgeon $1400 for breast reduction surgery. This has to cover all of the expenses for the surgeon, including running their office and seeing the patient after surgery. The cash price for breast reduction surgery is going to vary significantly. Surgeons fees are probably around $10,000 some charging more. The drawback to having this done as a cash procedure is that the procedure is quite lengthy, and the operating room and anesthesia cost becomes significant. It’s not just the compensation for the surgeon, but the cost for the facility and potential after care. You may be able to spend one night in the hospital if the procedure is done as an insurance based procedure. It’s definitely possible to do it as an outpatient procedure and that’s probably how most breast reductions are done today. Recognize that there’s a financial gain for most plastic surgeons to not accept insurance. The best way to the procedure will deliver is to see lots of before, and after pictures of previous patients who had very similar body and breast characteristics to your own. This shouldn’t be your first rodeo and if they have experience, they should have at least 100 sets of before and after pictures to show you. There should be no Misunderstanding of what your results are likely to look like. Without seeing pictures, we can’t really give you an assessment. Cop size is universally unreliable and subjective when it comes to determining breast size. Most insurance companies want us to remove about a pound of tissue. If you know what a pound of butter looks like that gives you a general idea. If the surgeon wrote a low estimated weight to be removed, then the insurance company is going to deny the authorization. All the surgeon has to do is increase the estimated amount of weight. There’s always some issue if the surgeon requests authorization for an estimated amount of weight and then removes less tissue during surgery. I’ve never seen insurance company Reverse authorization based on insufficient tissue removal, but it could happen. I think you should try to read between the lines and see if your surgeon is trying to get more income, which most likely is going to be the case. I hate to be cynical about this, but that’s how the world works. For insurance based breast reduction surgery, select surgeons who typically do lots of insurance based breast surgery to start with. This may include plastic surgeons who do most of the breast cancer reconstruction in your community. Those plastic surgeons tend to be a really good at breast Surgery in general. If you want to stay with your current provider, then ask your provider to show you lots of before and after pictures of patients who had the procedure done as a cash procedure or as an insured base procedure who had similar size breast to you in the before, pictures. Bring pictures of your body with you to use as a reference during all consultations. Recognize there is a financial gain to not accept insurance, but this makes the operation incredibly expensive for the patient who has an entitlement to have the procedure from their insurance. It’s a covered benefit. It seems fair to me that the surgeon should be able to charge the difference from the patient, but that’s not how the rules are set up. Sometimes a small amount of liposuction on the side of the breast on the chest wall can be done to improve the breast reduction outcome, and sometimes that can be seen as a cash cosmetic procedure that can alleviate the sometimes insufficient compensation to motivate good plastic surgeons to take insurance reimbursement. Generally speaking, it should be straightforward and surgeons should either accept insurance or not accept insurance and then serve as patient advocates and do what’s in the patient’s best interest. Sometimes the world just isn’t like that. I think once you recognize that surgeons may put their financial gain ahead of your well-being from time to time. If you sense, that’s the case then simply consult with other plastic surgeons until you find someone who is an advocate for what’s best for you. Plastic surgeons have the right to not accept insurance and for those providers Cash is the only way to go. I think if a plastic surgeon is going to accept insurance based work, then I need to recognize that that’s what the decision has been and they shouldn’t try to move patients from one category to the other on a case by case basis. I can’t speak I’ll behalf of what’s really happening in your situation but I know this comes up regularly and I personally would much rather make $10,000 than $1000. When I started practice, I gave myself two rules to always follow. The first rule was to always be a patient advocate first. That means one in doubt I would make decisions based on what I would want for my family. The second rule was to make a living for myself. The first rule always trumped the second rule and that’s how I’ve tried to practice. Be an advocate for your own needs. You have medical insurance and a breast reduction should be a covered benefit. It’s always a good idea to have a few consultations before selecting a provider and I suggest you do just that. Best, Mats Hagstrom MD