Will Insurance Cover Breast Reduction of EE and DDD Breasts?

Insurance carriers vary on what type of surgeries they will cover. Some insurance companies have a written exclusion for breast reductions and it becomes more difficult each year to have these procedures approved.  When an insurance carrier does cover breast reductions there are certain criteria such as symptoms of neck and back pain, grooving of the shoulders and intertriginous rashes.  The surgeon must evaluate and determine how much breast tissue will be removed and see if this amount meets the insurance carrier’s inclusion criteria. The amount is usually 500 grams per breast.

Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company but from your photos and description I believe that Medicaid will cover this procedure for you. Contact Medicaid and request their specific Criteria. Here is some general information however to help you :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 though insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses