How do I get my doctor to recommend a breast reduction so it can be covered by my insurance?

Insurance companies demand a certain combination of measurements and possibly photograph to determine whether or not they will cover breast reduction if at all. You can submit this yourself if you want to hasten the process.

Hi Jalia,I am sorry you are in pain.  We do many, many teens with your problem.  Insurance is very cooperative if you have all the symptoms, and are not really over weight and the PS can remove the required amount.  See the great, action-step, answer below.  All the best, Dr. Joe

Does your insurance require that you have a referral from your doctor to see a plastic surgeon? If not, see a Board Certified Plastic Surgeon that specializes in breast surgery to help you get authorization from your insurance. If you are required to get a referral from your doctor, get one of your parents to help you convince your doctor that you are serious about wanting to get this done. In the meantime, you might want to check and see if your insurance company covers breast reduction, not all insurance companies do. Secondly, you will need parental approval until you are 18, so take one of your parents with you for your consultation. Good luck!

     You can begin by contacting your insurance company to see if breast reduction procedures are covered by your plan and what deductibles or percentage of the surgery cost may be part of your cost share.  It is possible to self refer to a plastic surgeon by calling his/her office directly to make an appointment.     Criteria needed for a breast reduction to be covered by insurance may include amount of tissue to be removed, height and weight ratio, complaints of rashes and back and/or neck pain, with photos submitted as support.  Once you have met with the plastic surgeon his staff should be able to determine what your plan will cover and help you obtain the documentation needed.     My breast reduction patients are very happy after their surgery and find they are able to exercise more easily, feel healthier and wear clothes more confidently. Good luck in pursing your goal!

You need to check with your insurance policy to see if reductions are a covered benefit.  Then your primary doctor can give you a referral to a plastic Surgeon. Usually you just need to ask.

Start by checking your insurance policy criteria for breast reduction surgery, then bring that to your doctor and discuss your symptoms. Ask for a referral to a Board Certified plastic surgeon. 

My recommendation is to see a board certified plastic surgeon to evaluate if you are an appropriate candidate for breast reduction.  If you are seeing your primary care ask to be referred to a plastic surgeon in your insurance network.Unfortunately insurance carriers will have different criteria to determine coverage for a breast reduction but the most commonly used is amount of tissue removed.  Symptoms such as you describe such as pain and rashes help to support the medical necessity of the procedure.Breast reduction is one of the most satisfying of plastic surgery procedures for patients and I've had the privilege of helping many young women such as yourself.  Sometimes a call to your insurance carrier can help with logistics to see A plastic surgeon.Thanks for your question 

Are you seeing your primary care doctor, or a plastic surgeon?  There are several criteria that the insurance companies
utilize when determining whether or not to approve a breast reduction.
You may also want to check with your insurance company to see if your
policy covers the surgery. A consultation with a board certified plastic
surgeon can help you to understand what your options are. You would need consent from a parent or legal guardian since you are a minor.  Best
wishes.