Will TennCare approve my breast reduction? (Photo)

From your picture, you do appear to be a good candidate for breast reduction surgery. The symptoms you are experiencing are quite common. Many can include back, neck and shoulder pain, shortness of breath and difficulty completing normal activities. 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. However, any company or insurance provider in Tennessee has to only follow the requirements set by the state. This TN code only covers breast reconstruction after a mastectomy and surgery to correct asymetric breasts (breasts that are two different sizes). It would still be helpful for you to speak with someone from TennCare. #plastic surgery #breast reduction #insurance coverage #TennCare

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, you need to call your insurance company and see if they cover breast reduction surgery. Then, ask them exactly what criteria you would need to meet. Last, schedule a consultation with a board certified plastic surgeon in your area (link below) to discuss. Best, Dr. Nazarian