Best Insurance Companies for Breast Reductions?

Hi. I'm a 23 year old who is 5'8" roughly 145 lbs. and currently wears a size 30G bra. I am a student and my new insurance plan will be through Aetna. I am wondering if Aetna has a good track record with breast reduction surgeries...And if not, what would be your recommendation for an insurance company that might help cover my breast reduction surgery? Thanks for your help!!!

Doctor Answers 7

Breast Reduction and Insurance Coverage?

Thank you for the question.

Unfortunately,  I am not aware of the specific insurance company policies. You will need to check with the specific insurance companies.

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. Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.

Best wishes.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 reviews

Insurance and Breast Reduction

Unfortunately, each insurance company has their own criteria which can change from year to year so past coverage doesn't predict how they will respond now. . 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

Insurance and breast reductions

Each insurance company has different criteria for approval of breast reductions, you really have to check with your compnay to figure out what they require.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Best insurance companies for breast reductions

The "BEST" insurance company for a breast reduction is the ones that pay for it! Have your surgeon write a predetermination letter to see if you can be approved.

From MIAMI Dr. B

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

There are NO "Good Insurance Companies" for Breast Reductions

There are NO " Good Insurance companies for Breast Reductions". I am not here to speak for them nor to justify their practices except to remind you and other readers that an insurance company is a business whose primary obligation, as THEY see it, is to make money for their stockholders and investors. The primary objective these companies have is a great profit-loss statement and they way many of them achieve it is by increasing the amount of policies they sell, increasing the cost of each policy and decreasing the amounts they pay doctors and hospitals.

Breast Reduction is an easy service to dicker with because most people are largely not aware of the pain and discomfort associated with large breasts. They would much rather pay for massages, chiropractic treatments etc than to pay for the definitive treatment - a Breast Reduction.

To make things MORE confusing EACH insurance company sells many different policies, each of which "covers" different services. In other words, each insurance company confusingly acts like a restaurant in which patrons are handed different menus with different prices. There is no way of knowing if you have the same menu as the person next to you much less of your friend in another restaurant (IE different policy).

My advice to you is pick a plastic surgeon from and then see if your insurance company works with him/her. If they do, visit the surgeon and find out just how "good" (IE generous and willing) your insurer really is.

Good Luck.

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Insurance coverage for breasr reduction.

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1)  Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2)  Very big reductions (like from an F cup to a C cup) will usually be covered.

3)  Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4)  Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5)  DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6)  Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7)  Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8)  Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9)  Don't give up. If the first request is denied, demand an appeal.

10)  If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Good insurance company for breast reduction- something from the past

Unfortunately there are no "good" insurance companies for breast reduction anymore.  Most plastic surgeons will not accept payment in full as the insurance companies usually pay less than medicare or about 25% of their normal fee.  You will need to speak to several doctors in your area to see if they accept your insurance and  what your out of pocket expenses would be.  Good luck in your search.

Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 6 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.