Is there any way to get your health insurance to pay for a breast reduction if they say they do not cover that?

I have documented neck pains and shoulder pain with my regular physician. Now have been prescribed low dose pain medications going back tomorrow to my doctor my migraines are awful. I also recently been seeing a Orthopedic massage therapist but my insurance said they won't cover it. I am 34 DD probably bigger my left side is probably a F and my right side probably a small C. Which makes it harder tge pain is just so bad any suggestions I would appreciate.

Doctor Answers 3

If your insurance plan excludes reduction procedures

and you've exhausted your appeals for hardships. all you can really do at this point is pay out of pocket for it.  Fees will vary wildly at this point so call around and find the best pricing you can from a board certified PLASTIC surgeon.  In my market, I charge for a mastopexy (as reductions fees are much higher since insurance is involved) and include a reduction of the patient's choice with additional fees from the pathologist who will examined the removed tissue in addition to the OR and anesthesia fees.  This policy saves my patients huge amounts.


Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Breast Reduction and Medical Insurance

If your insurance company normally covers breast reduction but are saying that you do not qualify, you can appeal their decision. However if they say they do not cover breast reduction surgery in any case, the only thing you can do is choose another insurance company that does cover breast reduction. Good luck!

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 68 reviews

Is there any way to get your health insurance to pay for a breast reduction if they say they do not cover that?

It is difficult for patients to understand that insurance companies are not their friend. They are nothing more than a commercial company that sells a product in order to make a profit. They could be selling widgets or insurance contracts. They must make more money from you than they pay you and so they write legal contracts by which you are bound and which favor them. If you purchased a product (contract) that stipulated they do not cover breast reduction, then that was a joint decision by you to buy and by them to sell that product and you are both bound by that contract. However, there is nothing to prevent you from firing that company and buying a product that fits your needs although you would probably have a waiting period before surgery could be performed. Nowadays at least 75% of the reductions I perform are for cash, just like an enlargement. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 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.