Am I candidate for a breast reduction? And will IEHP cover it?

Question

Hello I am a 16 year old female, I weigh 155 and I'm 5'6 1/2, my breast size is a 34 DDD. My breast have not grown in more than a year and I have major back problems and neck and shoulder pain. I can not sleep at night sometimes because they're too big. When I run it hurts from the pulling. I have deep stretch marks and my nipples are very big and point downwards. My breast size has been causing me emotional stress and depression. I have my parents consent also.

Larry S. Nichter, MD, MS, FACS · Answer

Here are some basics about Insurance/IEHP Coverage Criteria for approval for #BreastReduction. First as you are a minor your parent(s) will have to give permission.  Breast Reduction coverage varies from insurance company to insurance company. In your case functional problems like back pain help: The more Physician recommendations for breast reduction the better - that would include your gynecologist, primary care doctor, plastic surgeon, chiropractor, etc. They want to see that you have already tried non surgical means such as weight loss, physical therapy, chiropractic treatments, etc but still have problems.. Contact your individual company and request their specific Criteria and request preauthorization.Insurance company favors approval for patient with functional problems like the ones you mentioned - back, neck and knee problems, bad posture, inability to run , etc.Your plastic surgeon will then contact your insurance company for preauthorization.Here is some general information however to help you :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

Ronald J. Edelson, MD · Answer

You should ask your parents to take you to a plastic surgeon. It is okay to perform breast reduction in a girl your age if the breasts are really causing you problems.  I don't know if your insurance plan will cover it however.  They usually cover very large reductions.  Your plastic surgeon can check with your health plan.

Stuart A. Linder, MD, FACS · Answer

If you have all symptoms associated with breast hypertrophy you may be covered! Have a board certified plastic surgeon evaluate and get authorizations. Best of luck !!

Am I candidate for a breast reduction? And will IEHP cover it?

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Am I candidate for a breast reduction? And will IEHP cover it?

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Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.