What Insurance Companies Cover Breast Reductions?

Question

I am looking into the possibility of getting a breast reduction, and I don't think my insurance policy covers them, even if they are determined to be medically necessary. I am 5' 0" and I wear a 34G. I believe that I am a candidate for a medically necessary breast reduction. Is there anyway to fight my policy, or should I look into getting a new policy?

Boris M. Ackerman, MD · Answer

Patients with excessively large breasts (breast hypertrophy) almost uniformly suffer from a rather severe set of symptoms.  Breast reduction in a properly selected patient  most definitely can be covered by most insurance policies.  There are a number of factors insurance companies consider in providing coverage, such as degree of symptoms caused by large breasts, prior attempt at conservative measures (which rarely works), degree of skin involvement, etc.  A plastic surgeon that has lots of experience with this type of procedure will also know precisely how to deal with the insurance company.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Based on your description you may be a good candidate for breast reduction surgery.

	If your insurance company does not cover breast reduction surgery,  it may be in your best interest to change policies.
	The best way to obtain 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.

	Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.

Otto Joseph Placik, MD · Answer

The first thing to do is go for an examination with a surgeon and have them submit an predetermination of benefits letter to your insurance carrier.

Peter A. Aldea, MD · Answer

There is NO DOUBT that a woman with G bra cup and symptoms associated with large breast wmay benefit from a Breast Reduction operation. BUT that is not how medical insurance companies operate.

When you purchased or received your coverage you agreedto pay a certain amount of money in exchange for the insurance covering a specific list of medical benefits. Your monthly bill depends on the length of that list of potential benefits. IF your policy did not include Breast Reduction benefits, you did not pay for them and your insurer willnever pay for you to have such service regardless of letters and protests.

On the other hand, if your policy includedBreast Reduction benefits, you need to find which Plastic surgeons work with your insurance. They will know what restriction its poses and the application process your insurance requires to approve your reques for surgery.
If you get a new insurance be careful not to be classified as a"preexisting" condition which would preclude you from having yoursurgery foranother year.
Good Luck,
Dr. Peter A. Aldea

Steven Wallach, MD · Answer

This question comes up all the time.  You should contact your insurance company and ask what there criteria are for breast reduction approval.

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