Will/how to get Anthem Blue Cross Blue Shield cover breast reduction for asymmetric breasts?

Question

I have asymmetric breasts, one is B, the other is DD. My bigger breast gets rashes every few month, and my smaller breast experienced chest wall aches (I got an ultrasound for it, then sent to an oncologist,) I also have pinches and aches in my back on the side of my smaller breast which I can only assume is due to my ill fitted bra and insert I have to wear. Doctors, how can I go about this, or have you seen this get covered through appeal?

Scott C. Lindsay, DO · Answer

Hello and thank you for your question. 
First, contact your health insurance company to see if this is a covered benefit  for you.  second, schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

Irena Karanetz, MD · Answer

Hi, Thank you for the question. 
Based on what you are describing, it does sound that you have large/heavy breasts along with physical symptoms, and breast reduction may be an option for you. However, it is difficult to tell without seeing the photos and/or in person consultation. 
Schnur Sliding Scale is a scale used by many insurance companies as a guideline for how much breast tissue should be removed in order to improve your physical symptoms. In addition, most insurances in order to approve the surgery, will require for 2-3 letters of medical necessity (from your chiropractor, primary doctor, OBGYN, Dermatologist, etc) demonstrating that your physical symptoms due to large breasts are not improving with conservative management. 
In patients with significant breast asymmetry, sometimes more breast tissue/weight is removed on the heavier side versus on the smaller side. 
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzFellowship-TrainedBoard Certified Plastic Surgeon

Warren Schutte, MD · Answer

Hi there, thanks for the question. It is certainly possible to get insurance coverage for breast symmetrizing procedures. The first step would be finding your plastic surgeon who is contracted with your insurance and go from there. The surgeon will aid in submitting your case to your insurance. I have seen cases like yours get covered. Good luck on your journey. My other tip for you would be to always consider cash prices if your insurance doesn't cover your case. Sometimes, with deductible, co/insurance etc, your payment through insurance ends up being more in the end than a cash quote from your surgeon.

Ronald J. Edelson, MD · Answer

If one breast is very large it might qualify for Fred i toon on one side. If it’s just asymmetry they will consider that to be cosmetic in nature.

Daniel Barrett, MD · Answer

Dear Energetic732024,
it is hard to tell for sure without an examination. It is unlikely that insurance will cover the costs of reduction of DD breasts. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Will/how to get Anthem Blue Cross Blue Shield cover breast reduction for asymmetric breasts?

Answers (5)