Breast Reduction Surgery 20, 128lb, 34DDD, can insurance cover it?

Once I was in high school I was a DDD. I had people grope at me, call me nicknames that referred to my breasts, and that was the thing people knew me for. I have terrible posture and when I sit up straight I have immediate pain in my lower back, exercising is difficult because I can't run or jump without hurting myself. I have embarrassing stretch marks.I just want to know if insurance would be willing to cover it since we have very little money otherwise and I can't wait any longer.

Doctor Answers 9

Can insurance cover it?

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. 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.
This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive.


Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Breast reduction, some advices:

Thank you very much for sharing your concerns with us. 
After having analyzed all the information provided to us, i can realize that you have very large breasts for your height and weight, and can be responsible for head, back, neck and shoulder pain.

In the future may cause  permanent osteo-articular damage in the back and shoulders and skin problems (mainly under the breasts). For for this reasons, certainly you need a breast reduction surgery.

Kind regards 

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 256 reviews

Breast reduction

Thank you for the question. I know it's sometimes intimidating for patients to bring up breast reduction with their physician,  I would recommend you start discussing this with your primary physician which will give you more documentation for insurance approval.  Based on what you have said and your measurements I think you would be an excellent candidate for breast reduction surgery. I would highly recommend you seek out a board certified  plastic surgeon to discuss this in person and start the insurance approval process. While all insurance companies differ I think likely if your  plan does cover breast reduction it sounds like you would be approved.  Good luck 

John Paletta, MD
Savannah Plastic Surgeon
5.0 out of 5 stars 20 reviews

Breast Reduction Surgery 20, 128lb, 34DDD, can insurance cover it?

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 we perform. Based on your description, it sounds like you may be an excellent candidate for the procedure.  



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. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.


Will

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. I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Breast reduction

If you want a breast reduction, you need to check with your insurance company to see what the criteria are to cover it.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

#breastreduction and insurance coverage

The answer to insurance coverage is that it depends on what insurance you have. Set up a consultation with a board certified PS that has experience in breast reductions. They will likely be familiar with insurance in your area and be able to guide you. You can also call your carrier and ask whether or not your specific policy will cover a breast reduction if you can have it determined to be medically necessary.

You surgeon will submit a predetermination of benefits to your insurance so that the insurance company can review your medical history and decide if you meet their specific rules for covering a breast reduction. -including dictating how many grams of breast must be removed.

From your description, it is likely that a breast reduction would help. Unfortunately, you will need to work through the insurance red tape. If they deny your request, please discuss pricing and financing options with your surgeon. Sometimes using insurance (especially if you have a high deductible) is not always the best choice.

Jack Peterson, MD
Topeka Plastic Surgeon
4.5 out of 5 stars 39 reviews

Will Insurance Cover Breast Reduction

It sounds like you would be a good candidate for breast reduction surgery. If your insurance will cover it will depend on your insurance policy. Some insurance policies exclude breast reduction surgery all together. You should either call your insurance to see if it is a covered procedure and what they require for authorization, or get a consultation with a Board Certified Plastic Surgeon who specializes in breast surgery who knows the ins and outs of insurance companies who can help you apply. Insurance companies that do cover the procedure have certain requirements that you will need to meet, such as; have you tried physical therapy, analgesics, special bras, etc. Good luck!

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 75 reviews

Breast reduction, can insurance cover it

This is a very common question and yes, insurance will often cover the procedure. The place to start is with a review of your insurance plan to see who is in your particular network, and after consultation your surgeon can submit a predetermination to know if you will qualify. Good luck.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Have to examine you to answer that

Find  board certified plastic surgeon that gets awesome results with breast reductions and see what they say.  Most women are fitted incorrectly in their bras and size doesn't equate to heaviness- insurance companies want a certain weight removed that they think will improve your overall help. Hope this helps.

-JGH

J. Garrett Harper, MD
Charlotte Plastic Surgeon
4.9 out of 5 stars 36 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.