Will Health First insurance cover a breast reduction?

Question

I'm 20 and I'm Now 34DDD. Weight 144lbs I have hard time breathing and I also have horrible back and neck pains. I will like to be 32 C I wanted to know who I go by getting my health insurance to help.

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

Vinod V. Pathy, MD, FACS · Answer

Thanks for your question.  Every health insurer has specific criteria that must be met before a breast reduction will be covered.  They may require specific documentation proving that more conservative measures (ie analgesics, physical therapy, chiropractic care etc.) have failed to improve your symptoms before they approve a procedure.  Others have specific volumes of tissue that must be met at the time of your reduction for the procedure to be covered.  Best to talk with you insurance carrier.  Good luck to you.

Robert L. Kraft, MD, FACS · Answer

LIke many insurers, Health First has criteria and prerequisites, but it does cover breast reductions. See an in network plastic surgeon who can review the rules of the road and begin the process with you.

William B. Rosenblatt, MD · Answer

Call  up the insurance company and ask them. This is your responsibility not the doctors. Find out from them who will do it and what it will cost you.

Will Health First insurance cover a breast reduction?

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Will Health First insurance cover a breast reduction?

Answers (4)

Answer: Breast Reduction

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