Would Insurance Cover my Breast Reduction? Am I Eligible?

i am 5'1 110-114 lbs. 18 years old and i am 28F. i have shoulder grooves can never sit up for long periods of time and neck pain.ithey caused me severe depression i was very active but now they refrain me from doing so. i dont go swimming because they make me feel very uncomfortable just look ridiculous on my frame.i hate them and i fear they are causing me to hate myself. i dont go out most days i lie and the bed and sleep thats the only time its painless. i just want my life back. please. 34b

Doctor Answers 5

Breast reduction and insurance coverage

Insurance companies have very strict criteria and you would have to call the insurance company to determine what theirs are.  You can go for a consultation and your surgeon's office may be able to investigate this for you.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Reduction and Insurance

Most likely you meet the criteria for coverage by insurance. The question is, does your insurance cover breast reduction surgery? Not all policies do, and each has their own requirements. I suggest that you see a board certified plastic surgeon that specializes in breast reduction and have your surgeon's office request authorization for you. They will know the ins and outs of getting approval for you. If you get denied, ask them to appeal your case. I have gotten many breast reduction cases approved this way. Good luck!

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 75 reviews

Insurance coverage for reduction

Your situation you describe is likely a covered procedure.  Most insurance companies use the Schnur scale to determine how much tissue needs to be removed to quality for a medically necessary procedure.  Make an appointment with your local plastic surgeon who accepts your insurance and see that he/she estimates that can be removed and determine if it will meet the Schnur minimums.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast reduction

You may be covered by insurance for a breast reduction.  Insurance companies do have strict criteria and you may want to investigate prior to seeing a plastic surgeon.  Some plans do not cover breast reductions, others require extensive physical therapy and symptoms such as rash and skin breakdown under your breasts.  If your plan covers breast reduction, see a plastic surgeon in consultation.  His/her office will be able to submit a preapproval on your behalf. 

Elizabeth Kim, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 28 reviews

Breast Reduction Candidate?

I'm sorry to hear of the problems your breasts are causing, both from the physical and psychosocial standpoints. However, with all due respect, it does seem somewhat extreme that you would “hate yourself” because of your breast size/position. I would suggest that you discuss these feelings with your parents, or other support that you may have around you. Sometimes, counseling is more beneficial than surgery…

Having said that, at some point you may be a good candidate for breast reduction surgery. Sometimes this procedure is covered through health insurance. The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” 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 “authorization” for the procedure.
 This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.  

Select your plastic surgeon carefully and ask to see lots of examples of his/her work. Communicate your goals carefully. Make sure you also learn about the downsides of breast surgery as well as a potential risk/ complications associated with the operation.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 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.