Will my insurance cover a breast reduction?

I am 35 5'4 125lbs and fit. I wear a DD/DDD, and have for my entire adult life. I am finished having children and tired of my large breasts causing severe neck/back pain, hindering workout activities, and generally causing headaches literal and figurative. I am concerned that due to my weight and relitive size of my breasts (not being a GG - If I gained 20lbs I can pretty much promise I'd be there.) that it will not be covered even if they are overly large for MY frame.

Doctor Answers 8

Insurance covering breast reduction

Most insurance companies do cover a breast reduction.  Some, unfortunately, exclude coverage for it.  It is prefereable to contact your insurance company to verify coverage, then consult with a plastic surgeon that takes that insurance.

Greenville Plastic Surgeon
4.9 out of 5 stars 112 reviews

Insurance coverage of breast reduction

Hi. Very often breast reductions can be covered by your insurance. However, it depends on your particular policy, as well as your preoperative documentation. It would be a good idea to check with your insurance company regarding the particulars of your policy. I would also recommend touching base with your primary care provider so that any symptoms you have related to the large heavy breasts may be documented. I would then recommend consulting with a board certified plastic surgeon who can go over that whole process with you.  I hope that helps.  Good luck and take care, Dr. Howell

Insurance and breast reduction

You should first contact your insurance company to see what they require in terms of criteria for approval. The go for a consultation.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Breast reduction with insurance?

The best option is to find a board certified plastic surgeon who accepts your insurance, consult with them and begin the pre-certification process with your insurance. Any supporting documentation you have can assist the process - whether it be notes from your primary doctor or chiropractor. As to whether or not it will be covered is up to your particular insurance policy. If you want to try to contact them directly you are also more than welcome to, they may be able to give you some ideas too.

Asaf Yalif, MD
Roswell Plastic Surgeon
5.0 out of 5 stars 6 reviews

Insurance coverage for breast reduction

If a breast reduction is a covered benefit under your policy, your insurance company will have certain requirements that will determine if they feel it is medically necessary. These requirements typically include back pain, shoulder pain, neck pain, bra strap grooving and rashes. Many require evidence of failed "conservative management" such as physical therapy, wider bra straps and ointments for the rashes. After that, they will require that a certain amount of breast tissue is removed from each side. This is based on your height and weight, but unfortunately every insurance company has their own scale. It would seem that for someone of your frame enough could be removed to make a DD into a C and make the insurance company happy. The best way to find out is to find a board certified plastic surgeon that is in your area that takes your insurance and go in for a consultation.

Ellen A. Janetzke, MD
Birmingham Plastic Surgeon
5.0 out of 5 stars 14 reviews

Insurance unpredicatble

The decision is made more on the height weight and amount of breast tissue the plastic surgeon says he is going to remove, each insurance plan has its own rules.

Insurance Coverage Breast Reduction

Thank you for your question. 
Insurance coverage for breast reduction depends on your symptoms, measurements, physical exam and, sometimes, pictures. Your board-certified plastic surgeon can help you through the insurance approval process to see if you are a candidate for coverage. 
Good luck to you.

Insurance and Breast Reduction

All insurances are different and some do cover breast reduction surgery. It wont hurt to at least meet with a surgeon that accepts your insurance to see if you would meet their requirements. The worst they can say is no.

Lawrence Bundrick, MD
Huntsville Plastic Surgeon
5.0 out of 5 stars 6 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.