What can I do to have insurance pay for a breast reduction?

I am in good health at 77, although I have lower back pain and some neck pain. I have large breasts. 40-42 GG with the right breast larger than the left. I have had large breasts since puberty.

Doctor Answers 3

Breast Reduction

You will need to see a plastic surgeon who accepts your medical insurance.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with and who is a board-certified Plastic Surgeon certified by the American Board of Plastic Surgery. Best wishes! Dr. Desai
Harvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 227 reviews

What can I do to have insurance pay for a breast reduction?

You would need to find a board certified plastic surgeon that is approved by your insurance and set up a consultation. Some insurances will require a referral letter from your primary care physician. Once you visit your surgeon, he/she will assess you and take pictures to send to your insurance to await approval or denial. Then you just wait to hear the verdict from your insurance, Even if they do approve your surgery, expect to still have some out of pocket costs to you such as possible co-insurance or deductibles. 

Lawrence Bundrick, MD
Huntsville Plastic Surgeon
5.0 out of 5 stars 7 reviews

How can you have insurance pay for a breast reduction?

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.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 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.