I am a DDD and have very serious back problems. Will medicaid pay for breast reduction?

Doctor Answers 5

Will Medicaid pay for a breast reduction?

Thank you for your question and you definitely have a problem and a reduction will reduce you back problems.  I will be difficult for Medicaid to pay for your surgery and I have never been able to get them to approve this surgery.  I would consult with a plastic surgeon who participates in Medicaid and is willing to go through the process of conservative therapy and multiple appeals.  You may be able to get this approved but it will take time. Good luck

La Jolla Plastic Surgeon
5.0 out of 5 stars 13 reviews

Breast reduction

Sounds like you would fit into the category of medically necessary. You should contact your insurance carrier to find a list of plastic surgery providers in your area, go see a few of them in consultation, pick one and proceed.

I am a DDD and have very serious back problems. Will medicaid pay for breast reduction?

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. It is one of the most patient pleasing operations we perform.
Based on your description you may be a good candidate for breast reduction surgery. You will do best achieving a long-term stable way prior to proceeding. The best way to obtain "insurance coverage" for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.
You may find that working with Medicare  that you will not be able to obtain “preauthorization”.
Make sure you are  working with a well-trained/experienced board-certified plastic surgeon who can demonstrate significant experience achieving the types of outcomes you will be pleased with.  
Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Breast Reduction

Hello and thank you for your question. Insurance will approve a breast reduction if they deem it to be medically necessary. If you are having back pain, it would be helpful to see your primary care doctor for a referral to a back specialist. Once they have ruled out other causes of back pain you can be evaluated by a plastic surgeon for a breast reduction. Best WishesTheodore T. Nyame MD  Harvard Trained Plastic Surgeon

Theodore Nyame, MD
Charlotte Physician
4.9 out of 5 stars 38 reviews

Impossible to predict

The decision is made more on the height weight and amount of breast tissue the plastic surgeon says he is going to remove, each insurance plan has its own rules.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 135 reviews

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.