Do you think I am eligible for my insurance to cover a breast reduction with blue cross blue shield?

I weigh 148lbs and am 6ft 7in. My breasts are 34 DDDs

Doctor Answers 5

Do you think I am eligible for my insurance to cover a breast reduction with blue cross blue shield?

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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 we perform. Based on your description, it sounds like you may be an excellent candidate for the procedure.  

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. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.

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. I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.

Breast reduction and insurance coverage

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Breast reductions are often covered by insurances depending on your breast size and symptoms. I would recommend a consultation with an experienced, board certified plastic surgeon to determine what is the best surgical plan for you and if you are a candidate for insurance coverage. 

Bahram Ghaderi, MD
Chicago Plastic Surgeon

I am I eligible for a breast reduction?

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Thank you for your question but the only way to know if you will meet the criteria is to call your insurance company and ask what their requirements are and what they will cover.  Each insurance company is different and I would first visit with a board certified plastic surgeon who can discuss with you what can be done give you realistic expectations based on your body.

John D. Smoot, MD
La Jolla Plastic Surgeon
4.7 out of 5 stars 14 reviews

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Breast Reduction

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I'm guessing you are 5'7'' rather than what you typed, but either way you may be a candidate for insurance coverage for a reduction of your breast size. The only way to know would be to see an experienced surgeon for a consultation and exam and then the surgeon will contact the insurance company with the physical symptoms and findings and the insurance company will let the doctor know if you meet their requirements for surgery.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

I am eligible for my insurance to cover a breast reduction.

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The only way to know if your insurance will cover breast reduction is to see a plastic surgeon in your health plan and have him complete a predetermination of benefits. You will then know shortly just what is covered.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 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.