BR and Insurance
Under certain circumstances Breast Reduction is covered by insurance. 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
Breast reduction - turned down by CCG
Thank you for asking about your breast reduction.
- It certainly is worth appealing.
- I suggest you contact CCG to find out why they turned you down and what you need to do to meet criteria.
- At least in the USA, and probably in the UK, it helps to hire a lawyer to file the appeal -
- Ask the specialist what in her/his experience has been most effective.
Always see a Board Certified Plastic Surgeon. Best wishes - Elizabeth Morgan MD PHD FACS