Considering breast reduction at 24 - would my insurance cover it?

Question

. I am currently a 40 DD with Droopy Breast and my right breast is much larger than the left it is so difficult to find a bra because the larger breast would slip out under the bra they are heavy I have herniated bulging disks down my spine and a pinched nerve in my neck the neck and back and shoulder pain is unbearable I believe it has to do with the large breasts I can't even buy certain shirts what fits my waist squeezes my bust. Would my insurance cover the procedure Emblem Health/GHI in NY

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

Reza Momeni, MD, FACS · Answer

Good evening dear, first thing, be sure to check with your insurance carrier to find our if your specific plan covers breast reduction.  If they say you have coverage, then you  might want to see  a plastic surgeon to see if you meed the criteria.

Steven Wallach, MD · Answer

You should check with your insurance company to find out their criteria for approval.  Then go see a plastic surgeon to be evaluated. Good luck.

Carlin Vickery, MD (retired) · Answer

Every insurance policy is different regarding requirements to be covered as medically necessary.  Your first step is to contact your insurance policy and ask them to give you their criteria.  Generally you will need to have documentation that you have failed conservative therapy to alleviate your symptoms.  This would include letters from your treating physicians as well as use of special bras, physical therapy etc.  Additionally you will need to see a plastic surgeon who will submit pictures as well as an estimate as to the amount of tissue to be removed.  Finally some insurance companies will look at your weight/height and body mass index to calculate what is considered medically necessary.

Considering breast reduction at 24 - would my insurance cover it?

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Answer: Insurance and breast reduction surgery

Answer: Insurance and breast reduction surgery

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Considering breast reduction at 24 - would my insurance cover it?

Answers (4)

Answer: Insurance and breast reduction surgery

Answer: Insurance and breast reduction surgery

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Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.