Will my Insurance Cover Breast Reduction?

I'm a 22 year old female who is 5'8" and 185 pounds. I wear a 40E cup, my nipples point downwards, and I have bad upper and lower back pain. Will Blue Cross, Blue Shield Alabama cover my breast reduction?

Doctor Answers 6

Insurance authorization for surgery

Each insurance company is different with what they require to "authorize" the breast reduction surgery through insurance.  I write a letter and send photos of the patient when trying to get authorization (I am sure most plastic surgeons do this as well).  Also getting supporting letters from other doctors who can document that you have had neck, back and shoulder pain and/or rashes due to the large breasts. Supporting documentation is usually very helpful.  

San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews



Insurance companies in the tough economy are clamping down on approvals for elective surgery. While it sounds like you qualify medically, it wouldn't surprise me if you were turned down the first time pre-approval was attempted. Appeals work though so I would not give up in that event. Good luck!



Best Regards,


John Di Saia MD

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 27 reviews

Insurance coverage Of Breast Reduction

The coverage of breast reduction surgery varies  among different insurance companies.  Most policies cover the procedure if certain conditions are met(chronic back/neck pain which has not been corrected by physical therapy, chiropractics, etc.).  There is almost always a threshold weight of breast tissue which is removed in relation to body surface area which tends to penalize taller women.  There are also some insurance policies which contain outright exclusions for reductions.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast reduction

First a pre-determination letter will be written by your plastic surgeon who will also submit pictures.  You sound like you have the right symptoms and large enough breasts to be approved.  Your insurance company usually has a website that will go over the criteria needed for a breast reduction to be covered - to know for sure.  Good luck!

Bivik Shah, MD
Columbus Plastic Surgeon
4.4 out of 5 stars 26 reviews

Will my Insurance Cover Breast Reduction?

Seek an in plan boarded PS to evaluate you. Than he can address a letter of predetermination the BC/BS of AL. with photos and CPT codes and ICD-9 codes. This will than be reviewed by the blues to determine if your plan will cover and your approval. Than the blues will send you and the doc a authorization letter. That's how we do it. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Insurance coverage and breast reduction.

From your physical description it sounds like you are within the range that most companies will consider. It is still highly variable depending on the company and the level of the policy. They may require a lot of information such as whether you have made a major attempt at weight loss or if you have had any treatments for the physical symptoms. In either case you should be prepared for a battle.

Sherwood Baxt, MD
Paramus Plastic Surgeon
3.8 out of 5 stars 25 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.