I am 30 years old and had big breast all my life. My back hurts all the time but i just keep moving.I have Medicaid as insurance. Im not sure if they help with breast reduction. How do i qualify for a reduction? I weight about 160 about 5'3 tall and wear 38H in a bra. Can you help me please ?
Need a Breast Reduction. I Weight 160 About 5'3 and Wear 36H. Can I Get Help?
Doctor Answers 5
Medicaid Breast Reduction
An 800 gram reduction will take you down to about a size D. Unfortunately, you have not provided any photographs or your desired size but you may qualify. However, finding a plastic surgeon willing to do it at Medicaid's reimbursement rate may be difficult. You may need to find a teaching program that will accommodate you.
Gary Horndeski, M.D.
Breast Reduction and Medicaid Coverage?
Thank you for the question.
You may be an excellent candidate for breast reduction surgery at some point; this operation tends to be one of the most patient pleasing operations performed. If you are not at a long-term stable weight, it will be in your best interest to reach this weight prior to undergoing breast reduction surgery.
Unfortunately, it may be very difficult to find the highest quality of care if you are seeking to have the operation covered through Medicaid. Many plastic surgeons no longer work with this organization given the bureaucratic hassles involved ( and extremely low reimbursement rates).
Given that your first priority should be safety as well as outcome of the procedure, you may do better by gradually saving up for the procedure and/or obtaining an alternative form of health insurance.
I hope this helps.
H cup breast reduction
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Breast Reduction Qualifications
Patient with symptomatic breast hypertrophy who wish to have insurance cover surgery need documentation and treatment of symptoms by their primary care provider. With some insurance, evaluation and treatment may also need to come from Physical Therapy or even a Physiatrist (Physical Medicine and Rehabilitation Specialist). After "failed" treatment, the patients are referred to a Plastic Surgeon, who then requests authorization from the insurance company to proceed with surgery. If breast reduction surgery is not approved through the insurance company, the only option is to pay out of pocket.
Thank you for your question and best of luck!
Gregory C. Park, M.D.
You need to see your primary doctor and let them know what you are going through and if they believe you’re your symptoms are good enough to qualify you for a reduction your insurance can pay for it. Or you can see a PS to have it done and you would pay out of pocket for the surgery.
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.