Will my Insurance Cover my Breast Reduction? 240lb, I Cup

I am 21. I am currently in an I cup and I want to get a breast reduction. I weigh 240, will my insurance (Cigna) cover a breast reduction for me. They hurt my back, bras are really uncomfortable and they just get in the way.

Doctor Answers 5

Your breast reduction will almost certainly be covered by your insurance.

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Insurance Coverage for Breast Reduction
Article by George J. Beraka, MD
Manhattan Plastic Surgeon

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1)  Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2)  Very big reductions (like from an F cup to a C cup) will usually be covered.

3)  Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4)  Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5)  DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6)  Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7)  Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8)  Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9)  Don't give up. If the first request is denied, demand an appeal.

10)  If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

Manhattan Plastic Surgeon

Insurance coverage for breast reduction

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Dear Becky,  Every insurance company is different and some have policies that exclude breast reduction surgery.  For that reason you must first review your policy to see if breast reduction is covered.  Once you have determined that it is possible to have coverage for breast reduction you will need to see a plastic surgeon for a comprehensive consultation.  Insurance companies now bse coverage upon something called the Schnur Scale.  This takes into account your height and weight to determine your body surface area.  You can then compare the Body surface area to the chart which determines how much tissue needs to be removed.  Somce insurance companies require you to be within 20% of your ideal body weight to be eligible.  Good luck with your surgery, Steven Schuster MD

Breast Reduction Criteria

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Health insurance carriers each have their own crieria in terms of weight and symptoms that their insured patients much demonstrate in order to qualify for a breast reduction. Your best course of action is to consult with a board certified plastic surgeon. During your consultation, you'll need to provide such information as your current weight, your bra size, if you are currently experience any local infection or breast pain, shoulder grooving, patterns of weight loss and how they affect your symptoms, etc. Your surgeon will then take multiple view photos and forward all the information to your health insurance carrier. I wish you the best of luck!

Jeffrey D. Hoefflin, MD
Los Angeles Plastic Surgeon

Breast Reduction covered by insurance?

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Each insurance is different with what they "authorize" but when you visit a surgeon, they can take photos and document your back pain and write a letter asking for authorization to perform surgery.  I suggest to my patients to bring in any documentation from other doctors, chiropractors, etc that can document what you are experiencing due to the large breasts.  I always send photos and a letter to the insurance company to get authorization.  I hope they help you - breast reduction patients are usually THE HAPPIEST patients around.

Criteria to meet for insurance to approve a breast reduction

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Dear Becky,

I usually recommend that patients desiring breast reduction covered by insurance provide as much documentation from other physicians to help their case. This would be documentation from your primary physician, chiropractor, orthopedic surgeon, spine surgeon, etc. The more 'proof' you provide that a reduction is medically necessary the more likely your insurance will approve the procedure. Symptoms that insurance carriers are looking for: back/neck pain, reduced quality of life, inability to perform common activities, shoulder grooving, difficulty sleeping, rashes/infections under breasts, headaches, painful breasts, etc. Best of luck, Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 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.