Will Insurance Cover my Breast Reduction?

I am 19, 5'4", 125 lbs, 32G and considering breast reduction. My back and neck are always terribly and painfully tight, I have indents in my shoulders, have low self esteem, and I am always uncomfortable. I can still exercise, but it is uncomfortable. Will insurance cover my breast reduction?

Doctor Answers 5

Insurance coverage for breast reduction

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The short answer to your question - it depends.  Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Please check your insurance policy to see whether breast reduction is a covered procedure. Often times, insurance company will dictate how much breast tissue to be removed. Please visit an experiences, board-certified plastic surgeon to learn about the procedure, its cons and pros, benefits, and alternatives. Please contact your insurance carrier to learn about inclusion and exclusion criteria. Best wishes.

Insurance coverage for breast reduction

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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

Breast Reduction and Insurance Coverage?

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I'm sorry to hear about the physical and psychosocial problems your disproportionately large breasts are causing you. 
It is probable that you are dealing with juvenile breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for your frame causing  both physical and psychological distress.

Sometimes breast  reduction surgery is covered through health insurance. You will need to address this question to your specific health insurance.

 If the procedure is a covered “benefit” through your health insurance, your next step would involve 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.
 When the time is right,  seek consultation with well-trained/experienced board-certified plastic surgeons.

 Best wishes.

Insurance coverage for breast reduction

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The easiest way is to call your insurance and see if breast reduction surgery is covered under your plan. You can also get a consultation with a plastic surgeon. Most of the time, your plastic surgeon is able to tell you whether you are a good candidate for breast reduction. It's very common for the insurance company to have a set of criteria to determine whether they will cover the breast reduction surgery. Your plastic surgeon should be able to help you with this process.

Best Wishes,

Stewart Wang, MD FACS, Wang Plastic Surgery

Breast Reduction and Insurance Coverage

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Each insurance company has its own policies in regards to breast reduction surgery.  The only way to find out would be to contact your insurance company to find out the criteria needed.  I would also recommend consulting with a plastic surgeon on your plan to determine if you are a good candidate for the surgery and to be able to explain the surgery to you.

Albert Dabbah, MD
Boca Raton Plastic Surgeon

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.