Will Tricare Prime cover my breast reduction a couple months before my 21st birthday, when I get taken off my parents insurance?

The costs for #BreastReduction varies by the following:Surgeon's expertise and experienceThe cost for anaesthesia and operating facilityThe geographic location you have the procedureEstimates can be obtained here on RealSelf , PlasticSurgery.org or Surgery.orgAlthough, #BreastReduction procedures are commonly covered by #insurance and required criteria, it is becoming more and more restrictive. Some practices do not accept insurance. However, ask the staff to assist you in obtaining pre-authorization so that you can attempt to be #reimbursed for out of pocket #expenses.

From your description it seems as if you are a good candidate for breast reduction. Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses

First call your insurance policy carrier and make sure that breast reduction is part of their policy. May patient has come to the office and apply for breast reduction coverage, only to find out that their policy just plain basically does not cover breast reductions. If Your insurance plan does cover breast reduction, then the next challenge becomes proving to your insurance carrier that you qualify for it based on their policy. for this, he will most likely need to be examined by the doctor 1st to formulate the plan and read a letter of request.

It is important to start the pre-approval process now.  It can take time to get pre-authorization.You only have about six months but this seems doable.See a PS for an exam soon.

Check with TriCare now so that, if there is a preauthorization process, you can beat the clock or fulfill any prerequisites.  Don't wait until the last minute! Good luck!

I am sorry to hear about the problems your disproportionately large breasts have caused.  Based on your description, you sound like you may be an excellent candidate for breast reduction surgery; of course, much more information is necessary to provide you with definitive advice.

Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, 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. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. Also, prepare to be persistent when dealing with health insurance companies. In regards to breast size desired, also communicate carefully. In my practice the use of goal pictures are helpful in this regard; a discussion of cup size can be confusing and imprecise. Therefore, I would not suggest that you communicate your goals and/or base your satisfaction with the outcome of surgery on achieving a specific cup size. For example, a "C cup" may mean different things to different people. I also find that the use of pictures is more helpful than the words “natural” or "proportionate” etc., which can (again) mean different things to different people. Many of my patients choose to have enough breast tissue removed to help alleviate symptoms while retaining enough breast tissue to remain proportionate to the remainder of their torso. Again, preoperative communication will be critical. I hope this, and the attached link, helps. Best wishes.

Hi, Insurance coverage of breast reductions depends on the insurance payer and their criteria.  Criteria usually include the amount of tissue to be removed based on your height and weight and your symptoms and how they were managed.  Good luck!