Will Medicaid cover a breast reduction?

Question

I use a 42 DD. I have been working out to lose some weight. Gone down from 265 to 230. It's getting harder over the years to continue to work out when I'm in constant back pain , neck pain, headache and shoulder pain. Using bras or sports bras my breast line is constantly tearing and burning. Will Medicaid cover a breast reduction.

Tom J. Pousti, MD · Answer

Thank you for the question. Based on your description, you may be an excellent candidate for breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.
Medicaid (and medicare) has been known to cover breast reduction surgery. For multiple reasons,  most plastic surgeons that I know of to not work with these organizations. I think finding a reputable plastic surgeon who will work with Medicaid will be the challenge you will face.
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.

Kenneth Hughes, MD · Answer

Medicaid may require that you try "alternative treatments" such as weight loss and physical therapy first. If you have records from your family practice or internal medicine physician documenting your neck, back, and shoulder pain over the years, this will facilitate the Medicaid preauthorization process. Typically insurance companies require 500 grams (3 cup sizes) reduction from each breast. Even if Medicaid funds the breast reduction surgery, many plastic surgeons are unable to cover the costs of the surgery with Medicaid's low reimbursement rates.  Some university settings with plastic surgery academic training programs may have a reduced fee available through a residency clinic.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Darryl J. Blinski, MD · Answer

Yes Medicaid does cover Breast Reductions. But the issue is finding a boarded S to accept that very low reimbursement as full payment. Plus many hospitals do not accept medicaid. Therefore you might want to see a residency program in plastic surgery to have your surgery.

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