What Insurance Companies Cover Breast Reduction?

 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.

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!

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.