Cigna Insurance for Breast Reduction Surgery.

I'm a 36G, so need breast reduction surgery to relieve back and neck pain. I read my policy documents carefully, and it says that they don't cover cosmetic surgery, however "This exclusion does not apply to Reconstructive Surgery to restore a bodily function or to correct a deformity." So my question is, is breast reduction surgery considered reconstructive surgery?

Doctor Answers 3

Cigna Insurance for Breast Reduction Surgery.

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 to perform.

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. 

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. 

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.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Cigna Breast Reduction

Cigna can be tough for breast reduction coverage and some of their plans do have total exclusions for breast reduction. They will usually say so specifically in the plan documents if there is an exclusion. Best advice for you would be to call Cigna directly and ask if they cover breast reduction under your plan . They may tell you that they will cover it if medically necessary. Try to get them to send you their exact criteria for coverage so that you are aware and you can take this to your surgeon. Also of course you'll need to make sure that your surgeon accepts Cigna. Getting insurance to cover breast reduction can be challenging, but it's usually worth trying. Best wishes-

Susan MacLennan, MD
Banff Plastic Surgeon
5.0 out of 5 stars 27 reviews

Insurance coverage for breast reduction surgery

Good question.  

Every insurance company is different in their description of what is cosmetic surgery.  Many insurances cover breast reduction surgery to address symptoms related to large breasts. If you have these symptoms and they have not been relieved by non-surgical methods, you may be a candidate for insurance coverage.  Other insurance companies specifically exclude breast reduction surgery.  The best way to find out would be to call your insurance company and ask if your plan covers breast reduction surgery.  Or you can get a consultation with a board certified plastic surgeon in your area and they will be familiar with your insurance plan.

Good luck,

Ralph Trey Aquadro, MD
Auburn Plastic Surgeon
5.0 out of 5 stars 37 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.