Will DC Blue Cross Blue Choice Plan Cover my Breast Reduction?

I am 4'11" 154 breast size is 42dd I've been suffering with neck and shoulder strain for yrs, I have blue cross blue shield blue choice plan help!

Doctor Answers 9

BCBS coverage

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Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX

Breast Reduction Insurance Coverage?

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Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. It is one of the most patient pleasing operations we perform.

Based on your description you may be a good candidate for breast reduction surgery; for  physical and emotional reasons.
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. Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.

Best wishes.

Breast reduction

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Blue cross will frequently cover breast reduction. However each pkan has specific requirements to obtain authorization

David L. Abramson, MD
New York Plastic Surgeon

Blue cross Blue shield coverage fo breast reduction

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Your best bet is to find a participating surgeon and go in for a consultation and have a predetermination of benefits letter composed to ascertain your level of coverage.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Breast reduction insurance coverage.

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Insurance Coverage for Breast Reduction

Answer by George J. Beraka, MD
Manhattan Plastic Surgeon
80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2) Very big reductions (like from an F cup to a C cup) will usually be covered.

3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7) Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9) Don't give up. If the first request is denied, demand an appeal.

10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Insurance coverage of breast reduction

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The best way to get accurate information about whether or not your insurance company covers breast reduction surgery is to contact them directly and find out what their criteria are for determining "medical necessity" for the procedure. Some criteria may include physical attributes such as height, weight and bra size, symptoms such as neck and back pain, and documentation of evaluation and attempt to treat symptoms by specialists such as orthopedic surgeons and neurologists.

Olivia Hutchinson, MD
New York Plastic Surgeon

Insurance coverage for breast reduction

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To figure out if your insurance will cover your breast reduction, you should contact the insurance company and ask them what their criteria are for approving breast reduction surgery.

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

BCBS coverage for breast reduction is possible

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I'll bet you're a good candidate for insurance coverage for breast reduction, given your data.  You will need documentation from a non-operating physician (your PCP, GYN, etc) regarding symptoms related to your breast size.  They will need to document your back pain, neck pain, shoulder pain, etc, document how long you've had this pain, what you've done to alleviate the pain, the fact that the pain returns despite these measures, and that they think a breast reduction would help you.

Then you'll need a consult with a surgeon board-certified plastic surgeon, who can get the ball rolling from an insurance approval standpoint.  Good luck!

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 46 reviews

DC Blue Cross Blue Choice Plan Cover my Breast Reduction

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Seek appointment with a provider plastic surgeon listed in your provider booklet. The provider plastic surgeon will examine you and write a predetermination letter to BC/BS. Then waiting for the response can be days to months, why? I really have no answer. If approved than your breast reduction surgery, hospital stay and anesthesia will be covered. Except for deductibles, co-pays, out of pocket plan expenses to the patient. In most incidences the out of pocket costs to the patient range from $500 to $2,500. Best of Luck. See if Drs. Scott Spear, Talal Munasifi are in your plan. Both great boarded plastic surgeons. 

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.