Would Insurance Cover Breast Lift to Relieve Pinched Nerve on Shoulder?

Question

My breasts are heavy and I wear tight bra straps 24/7 for support or else I have shooting pain down down the outer side of each breast. I have shooting pain/painful itching sensation toward the outer part of my shoulder and up the right side of my neck.Initially, I used slip on strap pads, then was given a Rx strength hydocortisone cream Nexttreated for shingles. The pain has not responded to anything. The Dr. suspects pinched nerve on my right shoulder.Will insurance cover Breast lift to provide some relief in the right shoulder area where I have to wear the strap so tightly?

Wayne I. Yamahata, MD · Answer

Important issues as to whether insurance would cover surgery for your condition include whether you need a breast lift or breast reduction. You didn&rsquo;t mention the size of your breasts but you did say they are heavy. It may be that the favored procedure would be a breast reduction. If the symptoms are well documented, a causal relationship has been demonstrated, and other conservative forms of treatment have proven unsuccessful than most insurance companies will cover a breast reduction procedure. Obtaining insurance coverage for a breast lift is more problematic because it may be difficult to establish a causal relationship between the sagging or ptosis of your breasts and the symptoms. It would be hard to justify a surgical procedure if we could not confidently predict a successful outcome.
To receive a more definitive answer to your question, I would recommend a consultation with a board certified plastic surgeon. If the surgeon believes that the surgery is necessary, he may be able to submit a preauthorization request to your insurance carrier to obtain this information.
I hope this information is helpful. Good luck and I hope you can obtain relief from your symptoms.

Jerome Edelstein, MD · Answer

Insurance doesn't usually cover the cost of a breast lift, however it can cover the cost of breast reduction if deemed medically necessary. This may apply to you. You should contact your insurance provider to find out if your surgery is covered.

Tom J. Pousti, MD · Answer

Thank you for the question.

	If your symptoms can be achieved it to hypermastia ( large breasts) then there is a chance that the insurance company makeup or breast reduction surgery. Most insurance companies require a certain weight to  be removed as part of their &ldquo;authorization&rdquo;.

	Obtaining insurance coverage for breast reduction surgery involves some &ldquo;hoops&rdquo; to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance &ldquo;authorization&rdquo; for the procedure. This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.

	I hope this helps.

Robert L. Kraft, MD, FACS · Answer

Insurance companies will attribute your neurological symptoms to macromastia and approve a breast reduction if you can corroborate failure of conservative methods to treat the back or nerve pain.  However, without removal of sufficient tissue to qualify as a reduction, insurance would not pay for a mastopexy.  You need to consider whether you would be happy reducing enough tissue for insurance coverage or if you want to maintain a larger size and pay for the procedure out of pocket.

Steven Wallach, MD · Answer

If you have very large breasts and require a reduction, then perhaps insurance will cover it for you, but not for a "straight" lift.

Would Insurance Cover Breast Lift to Relieve Pinched Nerve on Shoulder?

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Answer: Breast lift coverage for symptomatic issues

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Would Insurance Cover Breast Lift to Relieve Pinched Nerve on Shoulder?

Answers (8)

Answer: Breast lift coverage for symptomatic issues

Answer: Breast lift coverage for symptomatic issues

Answer: Breast lift coverage

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