Can insurance cover breast reduction surgery if it impacts my mental health? (Photo)

Breast reductions may be covered by insurance for medical necessary reasons like back, neck and shoulder pains interfering with activity of daily living.  Usually a trail of conservative therapy is necessary like physical therapy or chiropractor.  Additionally, the amount of breast tissue to be removed is part of the predetermination of insurance process.Cosmetic surgery is surgery to improve one's self esteem or mental health.  Cosmetic surgery is not covered by insurance companies.

Insurance companies cover breast reductions if you meet the weight criteria.  The weight is determined by your body surface area, which is determined by your height and weight.  Insurance companies usually require a minimum of 500 grams removed.  I recommend The Bellesoma Method to reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief and long term stability.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  Best Wishes,Gary Horndeski, M.D.

Hi and sorry to hear what you’re dealing with.  Your best bet is to contact your insurance carrier and find out from them exactly what their criteria are for covering a breast reduction.  Every plan is different, so do your own research to find out the requirements specific to your plan and if they pertain to you.A visit to a plastic surgeon's office will help you to understand if you're a candidate for the procedure, and what aesthetic outcomes are realistic in your particular case.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, always schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Best of luck,
Keith M. Blechman, MD
New York, NY

Hi and thank you for your question.  The best first step would be to contact your insurance carrier and inquire as to what their specific criteria is for medical necessity coverage for a breast reduction and to see whether or not you have out of network benefits.  Most insurance carriers have a preset criteria list that must be met to obtain medical necessity coverage, and this list often includes but is not limited to: 
Amount/weight of breast tissue to be removedDocumented back, neck and shoulder painDocumentation of failed conservative management and therapy (i.e. chiropractic, physical therapy, orthopedic, dermatological)Once you have contacted your insurance company, you should then contact a local Board Certified Plastic Surgeon to schedule a consultation to determine your candidacy for a breast reduction.  Your Plastic Surgeon's office would then submit all the necessary documentation to your insurance carrier in the hopes of obtaining medical necessity coverage and if denied they should also attempt an appeal on your behalf.I hope that this helps!