Can I get a breast reduction with Medicaid?

Question

I was given a referral for a reduction but the doctor left. I’m looking for a breast reduction doctor in NYC that accepts Medicaid but it is managed by Fidelis. I have 34E breast, I believe it might be bigger for it keeps growing. I can’t take the pain on my back and neck and I’m also sure it is starting to affect my breathing for I suffer from asthma. I come from a family from big breasted women, my mom had a reduction at 21 years old.

Christine Blaine, MD, FACS · Answer

Hi there and thank you for your question.  The criteria to obtain medical necessity coverage for a breast reduction is set forth by each insurance carrier/plan and can vary slightly between providers.  I would encourage you to contact your insurance company and ask for a recommendation or list of Board Certified Plastic Surgeons who accept your insurance.  I hope that this helps and I wish you all of the best.

Scott C. Lindsay, DO · Answer

Thank you for your question. I would actually recommend you call the member services number on the back of your insurance card, a representative will be able to give you a list of surgeons in your area that participate with your insurance. Good luck!

Nick Masri, MD, FACS · Answer

Thanks for your question, karina51091. Sorry to hear about your breast problems.
I think the best thing to do is to ask Fidelis for plastic surgeon recommendations in NYC. They should have a list of plastic surgeons who can help you with your breast reduction surgery.
Best of luck!

Reza Momeni, MD, FACS · Answer

You should ask your insurance to refer you to a doctor in your area that accepts your insurance.  RealSelf does not have listing of insurance and doctors that take them.

Robert L. Kraft, MD, FACS · Answer

Fidelis covers reduction if criteria are met. You must be 19 in addition to meeting all the other criteria including having conservative management and being within their weight standards. Good luck!

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