Will insurance companies approve a Breast Reduction in person that has Osteoarthritis in the neck with degenerative disease?

the breast are 38G

Doctor Answers 4

Will insurance companies approve a Breast Reduction in person that has Osteoarthritis in the neck with degenerative disease?

Insurance companies have tremendously varying guidelines.  Your ostearthritis and degenerative disease could work for or against you.  Because if you state that you are having a BR because of this neck problem insurance might say your symptoms are related to your OA and not excessively large breasts.  On the other hand they may say that yes your OA and degeneration is actually a result of your excessively heavy breasts, which by the way is the reason why insurance companies authorize BR surgery in order to prevent degenerative diseases in the neck and shoulders.  So, just the amount of tissue being removed is no longer a standard guideline for insurance companies, and they look at your symptoms, BMI, and whether you have undergone "conservative management" (whatever that means!).  A consultation with an experienced board-certified plastic surgeon can guide you in the right direction. 

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

Breast Reduction

It is generally easy to get it covered if you are taking off at least 400-500grams of tissue. If less than that, it will be tough.

Frederick G. Weniger, MD, FACS, MBA
Hilton Head Island Plastic Surgeon
4.9 out of 5 stars 35 reviews

Will insurance companies approve a Breast Reduction in person that has Osteoarthritis in the neck with degenerative disease?

Based on your brief description, you may be a good candidate for breast reduction surgery. Of course, in person consultation will be necessary to give you definitive advice.  Generally speaking, breast reduction surgery is one of the most patient pleasing operations we perform. By removing “excess” breast tissue, adipose tissue, and breast skin  this operation reduces and lifts the breasts to a higher position on the chest wall. By doing so, patients often find improvement in neck, back, and shoulder discomfort and find it easier to form their activities of daily living and exercise.

Sometimes breast  reduction surgery is covered through health insurance. The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” 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 “authorization” for the procedure.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.
When the time is right,  seek consultation with well-trained/experienced board-certified plastic surgeons.

I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 reviews

Breast Reduction with Osteoarthritis

Every insurance company/policy is different.  You can contact your insurance company for details regarding your benefit coverage.  When you meet with your plastic surgeon, you will review the aches and pains you are having and your surgeon will be able to tell you if it sounds like a breast reduction will help alleviate your problems.  It is possible that your osteoarthritis of the neck is actually causing your neck pain, not your breasts.  Your insurance company has certain criteria, including height and weight limitations, that will dictate if your breast reduction will be approved.  The bottom line is that you won't know until you visit your surgeon and have a discussion about your particular case.

Emily J. Kirby, MD
Fort Worth Plastic Surgeon
4.6 out of 5 stars 19 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.