Hunchback Much? Mom of 4 With No Insurance? (photo)

Mom of 4 worked perdiem with no insurance. So no doc visits even though I have head, neck, shoulder, nerve and rib pain. Now I finally have insurance!! I want to see if I qualify medically for reduction. The only health care I have documented recently is at my weight clinic where I lost 35 pounds. I'm 33 5'2 148 pounds saggy 38DDD and I had to throw in the hunch back that I hate so much! Would a hunch prove I'm about to fall over or will my insurance tell me to go exercise!

Doctor Answers 8

Insurance coverage for breast reduction is unpredictable.

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You are a good candidate for symptomatic relief from breast reduction. Whether or not insurance covers the procedure will require investigation.

Breast reduction coverage

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You seem to be a good candidate for breast reduction procedure. You should see a board-certified plastic surgeon who will ascertain medical necessity and provide information to your insurance company and get approval on your behalf. This process is done very successfully in my office.

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 112 reviews

Hunchback Much? Mom of 4 With No Insurance?

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Health insurance should offer you coverage but you might have out of pocket expenses. Best to see a boarded PSs in CA. 

Breast reduction

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Most insurance companies cover great reduction but you may have a waiting period before something like that is covered.  Check with your insurance company what their policy is, then get evaluated by a plastic surgeon who can help you with the authorization process.  

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Breast Reduction Candidate?

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Thank you for the question and pictures. Based on your description, you may be an excellent candidate for breast reduction surgery. You have done well in losing weight;  hopefully you can achieve a long-term stable weight prior to proceeding with breast reduction surgery.  I do not think that the presence of a “hunch” will necessarily help your case when it comes to insurance coverage.

The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. 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.

Also, when dealing with health insurance companies, prepare to be persistent. As you go along, remember that breast reduction surgery is one of the most patient pleasing operations we perform.

Best wishes.


Hunchback Much? Mom of 4 With No Insurance? (photo)

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Thank you for your interesting question.  Insurance companies have different guidelines for covering breast reduction.  Even within the same company guidelines vary from one policy to the other.  By most standards you do qualify, but your plastic surgeon's office has to check your policy.  Recently most insurance companies are requiring a 6-month period of "conservative" management, whatever that is!  At any rate, your back, shoulder, neck problems, and the rash and infection you probably get under your breasts have to be documented by your doctor and it has to be documented that these are all related to excessively large and heavy breasts.  Please make sure you are under the care of an experienced plastic surgeon, specifically in the area of breast reduction, who is certified by the American Board of Plastic Surgery.  Best of Luck.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

Breast reduction and insurance

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Insurance companies are making it harder and harder to  approve.  I have one patient that because of her persistence took one year to get final approval!  Check with your insurance company regarding their requirements.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast Reduction

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It sounds like you would be an excellent candidate for a breast reduction. Consult with an experienced surgeon and his office will send the necessary info to your insurance carrier so they can make a decisioin on your qualification.

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