Im 5"6 190 pds size38 JJ ive tried everything. Does Medicaid Cover Breast Reduction?
Doctor Answers 3
Medicaid "covering" breast reduction
There is no simple answer to the question of whether Medicaid "covers" breast reduction as the definition of what is "covered" is up to the state and federal government as well as the definition of what constitutes a breast reduction. Medicaid will not tell a physician before the surgery whether the procedure will be covered but expects the physician to perform the procedure and bear all the cost/risks and then submit the bill for reimbursement. Medicaid then decides whether they will pay for it, how much they will pay, and when they will pay. This is not conducive to a reasonable system of health care delivery, particularly for elective procedures even if non-cosmetic. You might check and see if your area has a university medical center where there is a plastic surgery training program as this setting is more likely to be able to help you.
Breast Reduction - Insurance Coverage
In general, insurance coverage for breast reduction is likely to be obtained as long as enough breast tissue is being removed. That varies from person to person and is a function of your preoperative breast size, height, weight and any mitigating medical and health factors. In your case it seems likely that Medicaid will "cover" the procedure, but the next step is finding a board-certified surgeon you're comfortable with who participates in Medicaid and is therefore willing to accept the Medicaid allowance for the surgery as the surgical fee. Once you're done that you can discuss the specifics of your surgery with that surgeon.
I hope that this helps, and good luck,
Breast Reduction and Medicaid Coverage?
Thank you for the question.
Yes, as far as I know, Medicaid does cover breast reduction surgery. You may have to do some searching however to find well qualified experienced board-certified plastic surgeons who work with the Medicaid organization.
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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.