Will medicaid cover breast reduction?

Question

I am a healthy 42 yo. that works out regularly but I can't seem to make a dent in my massive breasts regardless of the exercises I do. I am a 34G with severe daily neck and shoulder pain from simple tasks like doing dishes and I would love to be able to clean my house like a normal person without the chronic pain from heavy breasts. Where/how do I begin the process of a necessary reduction?

Sheila S. Nazarian, MD · Answer

You will need to call your insurance company and see if they a) cover breast reduction surgery and b) what exact criteria you would need to meet. Then, schedule a consultation with a board certified plastic surgeon in your area (link below) to discuss. Best, Dr. Nazarian

Jed H. Horowitz, MD, FACS · Answer

Insurance will generally pay for breast reduction surgery if more than 400 – 500 grams are removed from each breast. Of course this is dependent on your individual insurance company requirements. Problems including neck pain, back or shoulder pain, hygiene difficulty, and breast pain are considered medically necessary conditions for reduction surgery. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions. I suggest that you start with a board certified plastic surgeon to evaluate you. Your next step would be to determine if you insurance plan covers breast reduction. In the meantime, keep up the exercise. Regular exercise and good health prior to surgery will help with your recovery process. Good luck!#plastic surgery #breast reduction #insurance coverage

C. Bob Basu, MD, MPH, FACS · Answer

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. BasuHouston, TX

Will medicaid cover breast reduction?

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