What Insurance Companies Cover Breast Reduction?

Question

Hello yes I need some advice I am 19years old and last time I got measured I was a size F now I am pretty sure they grew alot since I was last measured I just had my second child on april 21, 2011 I am in so much pain my back is hurting so badly that I can barely walk or move sometimes. I am 5'5. I was seeing if anyone knows any insurance company that can cover for a breast reduction. I really need it I take pain killers but none of them help at all with the pain, I also tryed a heating pad nothing I really can't deal with the pain anymore I barely can hold my one aughter because she to heavy it makes the pain worse and I dont like that I cant even hold my daughter because of my breast being to big it causing the back pain.

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

Unfortunately, each insurance company has their own criteria. 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.

Tom J. Pousti, MD · Answer

Thank you for your question.

	Insurance companies do cover breast reduction surgery but each has their own criteria for authorization.  It helps to have documentation from other physicians stating that the size of the breasts are causing you neck, back and shoulder pain.  In my practice, I send a letter as well as photos of the patient to the insurance company for authorization.

	Best Wishes!

C. Bob Basu, MD, MPH, FACS · Answer

Every insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.
	Best wishes,

	Dr. Basu
	Houston, TX

Peter A. Aldea, MD · Answer

Re "I was seeing if anyone knows any insurance company that can cover for a breast reduction" .

	The vast majority of medical insurance companies cover breast reduction surgery but have different requirements you must meet BEFORE they will agree to partially pay for it (minus your copay and deductible). You must know that many have a pre-existing condition clause, which means you may have to be on the insurance for over a year before they would consider you eligible for this service.

	It is best to discuss this with the HR person at your job.

	Good Luck.

	Dr. Peter A Aldea

Darryl J. Blinski, MD · Answer

Mo9st companies have a policy to cover breast reduction surgeries. You need to contact your insurance plan to see the steps needed to be pre approved.

What Insurance Companies Cover Breast Reduction?

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What Insurance Companies Cover Breast Reduction?

Answers (7)

Answer: Insurance Coverage of Breast Reduction

Answer: Insurance Coverage of Breast Reduction

Answer: What Insurance Companies Cover Breast Reduction?

Answer: What Insurance Companies Cover Breast Reduction?

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