I'd like to know if my Aetna Insurance would cover my Breast Reduction?

Hello.. I am 4'11 weight 131lbs 43 yrs old. Im wearing size 36DDD , I like to know if my Aetna insurance would cover my breast reduction? All information regarding this matter is great appreciated . Thank you. .

Doctor Answers 6

I'd like to know insurance would cover my Breast Reduction?

 Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. This operation tends to be one of the most patient pleasing operations to perform.

Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, the more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. 

This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. Also, prepare to be persistent when dealing with health insurance companies. 

In regards to the outcome of the breast reduction surgery, the most important decision you make will be careful selection of your plastic surgeon. I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.

Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. ***Ask to SEE lots of examples of their work AND preferably speak/see patients who have had similar procedures done.

I hope this, and the attached link, helps. Best wishes.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Breast Reduction

You should call your insurance company first and ask them what is covered and what non-surgical therapies are required (physical therapy, etc).  

I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with and who is a Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery.

Best wishes!

Dr. Desai

Urmen Desai, MD, MPH, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 233 reviews

Breast reduction - will my insurance pay

Thank you for asking about your breast reduction.

  • You cannot get an answer on-line because every insurer is different.
  • First check your policy and see if breast reduction is excluded. If it is, insurance will not pay.
  • Pay if it is not excluded, find the criteria you must meet for surgery.
  • It may be 6 months of chiropractic care for example.
  • Then have a consultation and have your surgeon submit a pre-determination report.
  • Once your insurer has the report, they will let you know if they will cover your surgery.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Insurance and breast reduction

You should first check with your insurance company regarding their coverage criteria, and then seek out a plastic surgeon to be properly evaluated. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Aetna coverage for reduction

Probably yes so long as you are able to meet the conservative medical management criteria. See a board certified plastic surgeon who can walk you through the preauthorization process. Aetna requires a minimum of three months of chiropractic or physical therapy, mammography and other supporting documentation. 

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

Insurance covering breast reduction

I think there is a good chance that your insurance will consider your breast reduction medically necessary. You will need to present for a formal consult with your treating surgeon. The insurance company will want an estimate of weight of breast tissue that will be removed relative to your body surface area, which is calculated from your height and weight. This is very difficult to predict accurately based on cup size.

Frederick W. Ehret, MD
Tacoma Plastic Surgeon
4.9 out of 5 stars 46 reviews

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.