Will Insurance Cover my Breast Reduction Surgery?

I'm 5'7 185 and a 36J. I was 166 last year & the same size. It's hard to jump, run, climb! I have been suffering from back pain for the last 10 years, I can't sleep at night and my back aches, I toss and turn and I have to cross my arms out in front of me to be comfortable and they "go to sleep". I think I have at least 400/600 grams that can be removed and still be at a C/D! I have BC/BS Iowa

Doctor Answers 8

Weight removal required for insurance coverage

Breast reduction is covered by insurance companies if you meet 2 criteria.  One, you have symptoms secondary to large breasts and two, you need weight removed that meets their demands.  From your height and weight, your body surface area is calculated to determine the grams of tissue that need to be removed.  At 36 J, each 200 grams of weight removed would correspond to 1 cup size reduction.  600 grams would correspond to 3 cup size reduction.  You will need to speak with your BCBS carrier to determine if you meet the weight requirements.

Best Wishes,

Gary Horndeski, M.D.

Texas Plastic Surgeon
4.6 out of 5 stars 224 reviews

Breast Reduction and Insurance Coverage?

Thank you for the question and picture.

Based on your description you may be an excellent candidate for breast reduction surgery; it is one of the most patient pleasing operations we perform.

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.

Make sure you are  consulting with  well-trained/experienced board-certified plastic surgeons.  
Also, be prepared to be persistent when dealing with health insurance companies.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,503 reviews

Insurance coverage

Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 212 reviews

Breast Reduction and Insurance

It sounds like you are an excellent candidate for breast reduction surgery. But it will all depend on what your insurance policy says. Insurance companies can have several different types of policies that each have different types of coverage. You should see a Board Certified Plastic Surgeon who specializes in breast reduction surgery and your surgeon will be able to help you get pre-approval. If you get denied, ask your surgeon to appeal your case. You will need to have documented any type of treatment you have done to help with the discomfort of your large breasts. Such as physical therapy, special bras, analgesics, etc.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 76 reviews

Insurance coverage for breast reduction

The best way to tell if your insurance will cover your breast reduction surgery is to see a board certified plastic surgeon. He or she will examine you and be familiar with the insurance companies' policies in your area. He or she will also be able to prior authorize with your insurance to determine in advance whether they are likely to cover your surgery. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon
3.6 out of 5 stars 13 reviews

Insurance Coverage of Breast Reduction Surgery

Every insurance company is different and there are evrn differences state to state.  In heneral, most insurance companies require significant impairment (neck pain, back pain and skin infections under the breast are a few examples) that has not responded to therapy such as weight loss, pain medications and/or physical therapy. I would recommend a visit to your primary care physician for initial treatment.  It's also a great idea to call your insurance carrier to get a thorough understanding of their rules.

Andrew Jimerson, MD
Atlanta Plastic Surgeon
4.4 out of 5 stars 544 reviews

Insurance and breast reduction coverage

Each insurance company is a bit different, and you should check with them about coverage. A good start after that is to go for a consultation with a plastic surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Will Insurance Cover my Breast Reduction Surgery?

Sorry, but your question is imposssible to answer without an examination. See an experienced and board certified plastic surgeon. He will be able to get a good idea of what it would take to reach your goals and then will contact the insurance carrier to get preapproval for you. As you may know from reading through this site, breast reduction patients are probably the most happy patients in a plastic surgeon's practice because of all the benefits obtained from the surgery. Godod luck.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 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.