Will Affinity Health Care pay for my breast reduction?

Question

I am 18, 5'3, about 145ibs, and have 36E breasts. I only want to go down to be a 36D. I have terrible back, neck, and shoulder pains that causes very strong and terrible migraine headaches as said by my doctor.

Sheila S. Nazarian, MD · Answer

You will need to call your insurance company and ask if they cover breast reductions and if so, find out what the criteria are. Then, schedule a consultation with a board certified plastic surgeon in your area (link below) to discuss. Best, Dr. Nazarian

Larry S. Nichter, MD, MS, FACS · Answer

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive.

Jed H. Horowitz, MD, FACS · Answer

Breast Reduction: insurance coverageThis will depend upon your insurance policy but they must follow certain standards as well The best thing to do is schedule a visit with a
plastic surgeon who can contact your insurance company for authorization after
performing an examination and documentation of your symptoms. You should also
consider going to your primary physician for an examination and documentation
as well. Insurance companies have a number of requirements and an examination
will be able to determine if you are a candidate for reduction. Good luck.

#PlasticSurgery #BreastReduction
#Insurancecoverage

Norman M. Rowe, MD · Answer

your doctor would have the take this insurance. It really matters on a case by case basis. You could call your insurance to check this as well.

Robert L. Kraft, MD, FACS · Answer

Affinity does cover reduction but going from an E to a D may not be enough in terms of gram weight resection to fulfill criteria or alleviate back and shoulder pain. Macromastia is not related to migraine headaches.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problems your disproportionately large breasts have caused.  Breast reduction tends to be one of the most patient pleasing operations we 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. Best wishes.

William B. Rosenblatt, MD · Answer

Insurance companies will not tell you if they will or wont. First you need to see if there is a plastic surgeon who accepts this insurance. Then you need to see them and have him and your other doctor document your medical issues. Usually the insurance companies will deny payments. If you really want the surgery, you will usually have to pay for it.

Will Affinity Health Care pay for my breast reduction?

Answers (7)

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