Do I qualify for a breast reduction covered by insurance? (photo)

This is a question best suited for your insurance company. Give them a call and ask what their policy is on covering breast reductions, what kind of documentation do you and your doctors need to provide and go from there.All the best,Moises Salama, MD

Based on your clinical history and your photo, it's very likely that your insurance would cover your breast reduction, depending of course on the type of policy you have. Discuss this with a plastic surgeon and submit your case for approval.Best wishes,Dr.Bruno

Hello and thank you for your question.You appear to be a good candidate for breast reduction surgery. Many Insurance companies will cover this procedure.I suggest you call your company and see what criteria they require. Best of luck!

From your description, you sound like you would be approved for breast reduction surgery. However, it will depend on your insurance. Some policies will cover breast reduction if you meet their criteria, and other policies exclude it. Check with your HR department to find out if it is covered, or see a board certified plastic surgeon that accepts insurance and can help you get pre authorization. Good luck.

BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered by most medical insurance providers.  If not, they may try to deny you based upon a lot of things such as lack of symptoms, lack of previous medical management, and lack of enough tissue that should be removed. The insurance companies will dictate the amount of tissue to be removed, not the PS.  
Read your medical insurance certificate of coverage. Determine what medical information is required for your medical insurance provider to issue a pre-authorization or predetermination of benefits for the BR and then work with a board certified PS who accepts your medical insurance.
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Candidates for reduction will typically have documented evidence of neck/back and shoulder pain as well as rashes and bra strap grooving attributable to the increased breast weight. They will often demonstrate that these symptoms have been resistant to more conservative measures like therapy, weight loss and pharmacologic intervention.
In addition to establishing a case for medical necessity, there are also requirements for resection weight (when covered by insurance). This may be a standard "500 gm per side" stipulation or a more variable standard based upon body surface area/Schnur scale. It is important to realize that these weight requirements can occasionally exceed your goals for size reduction. Insurance coverage is contingent on these requirements being met, thus cosmetic concerns become secondary(i.e. cup size goals).
Based on your photos and narrative, you would seem to be a reasonable candidate. The absolute requirements from each insurance provider will vary but that being said your clinical narrative checks all the proverbial boxes.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Top 100
RealSelf Hall of Fame

You are an excellent candidate for The Bellesoma Method.  This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  Unfortunately, this technique is not covered by insurance.Best Wishes,Gary Horndeski, M.D.

Dear AlexLetourneau,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Looking at your photos and your symptoms of back pain along with the fact that you are requiring treatment by a chiropractor for back  are all important criteria needed for insurance coverage for breast reduction surgery.   If you have any rashes and have been treated with creams by dermatologist,
this is also helpful in supporting your need for breast reduction surgery.

Hello! Thank you for your question. Breast reductions which
are medically necessary (e.g., if you have rashes under your breasts or if you suffer
from back, shoulder, and neck pain) are covered by most
medical insurance providers. Occasionally medical insurance providers
may try to deny you based upon a lack of symptoms, lack of previous
medical management, and/or lack of enough tissue to be removed. 
Read your medical insurance certificate of
coverage. Determine what medical information is required for your medical
insurance provider to issue a pre-authorization or predetermination of
benefits for the breast reduction surgery. Then, gather that information,
and schedule a consult with a plastic surgeon.
Keep in
mind that if you decide to pursue surgery it’s very important that you find a
surgeon whom you are comfortable with and trust and who evaluates you
in-person, addresses your concerns, and tailors an individualized treatment
plan for you and your aesthetic goals. Best of luck!
Matthew
A. DelMauro, M.D.