How to get approved for a breast reduction?

I am 30 Years old in Chicago, I had weight loss surgery in 2014, I have lost almost 100lbs but I am having a issue with completing my weight loss journey due to my breast being large, it's hard to do a lot of physical activity, and I am having headaches, upper back pain, my bra straps are cutting into my shoulders I have dents from the weight of the breast hopefully they are not permanent. I have Aetna Choice POS II It is hard to find if the reduction will be covered by my insurance.

Doctor Answers 3

Approval for a BR

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

You have to contact your insurance company and find out what their criteria are for approval. Then you shoudl go see a plastic surgeon for evaluation.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Breast reduction - how to have it covered by insurance

Thank you for asking about your breast reduction.
  • I am so glad you are doing well after your weight loss surgery.
  • First call your insurer and ask if breast reduction is covered and ask for a list of the specific criteria you need to meet for insurance to cover the surgery.
  • If you have met the criteria, then ask for the list of plastic surgeons in your network and schedule an appointment.
  • Your surgeon will submit a predetermination letter to your insurer.
  • And you will be either approved for surgery or denied.
  • If denied, you can appeal.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

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.