Trying to get my medi-cal to cover breast reduction in Fresno, CA. How do I know I qualify for a breast reduction? (Photo)

Question

7th grade I was 32 DD100 lbs. after my first child when I was 17 150lbs 36 DDD. I lost weight I went down to 135lbs but my breast stayed the same.2nd child 20 170lbs 42F. I want to lose weight again but my breast is causing lots of back and neck pain. I've been walking 3 miles a day but when I want to do more exercise such as crunches jumping Jack's etc I get so much chest pain from the weight. I was wondering would my insurance cover breast reduction or if breast reduction good decison for me.

John D. Smoot, MD · Answer

Thanks for your question but my experience with Medical and Medicare is that they rarely will cover this procedure.  You can try but you will need to go through a lot of hoops to prove you really need it even with conventional insurance.

Michael F. Bohley, MD · Answer

I am not familiar with Medi-Cal. However, if it is similar to the Oregon Health Plan, it probably does not cover breast reduction. This is unfortunate because the breast reduction procedure can be a very positive change for many women. As you've noted, it's very difficult to work out and stay in shape while dealing with excess breast weight/volume. Many patients that can't get approval will finance the procedure in order to get it done. I would discuss this with your local plastic surgeon's office prior to your consultation. Best of luck to you.

Andrew T. Cohen, MD, FACS · Answer

I am not a Medi Cal provider so I can not say for sure but I do not believe that Medi Cal covers a breast reduction surgery.  Insurance companies are making it harder these days for authorization.  Best bet is to try and finance it thru a company like Care Credit.

Trying to get my medi-cal to cover breast reduction in Fresno, CA. How do I know I qualify for a breast reduction? (Photo)

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