Would my American Blue Cross Blue Shield Student Insurance Cover my Breast Reduction Were I to Need One?

I'm just about exactly 5 feet tall, I weigh 154lbs and when I entered my measurements onto a breast sizing generator, it told me I'm a 34 J. I don't understand if that could be true or not, but I kind of believe it now because I can never find any bras that fit and have to resort to wearing 6 bras at a time, which get tighter the more I wear. I went through physical therapy because of my back pain and headaches. Please help! This is my biggest problem.

Doctor Answers 6

Will Blue Cross Cover Breast Reduction?

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Every insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX

Breast reduction coverage

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It would help to see photos to get a better idea.   Most insurance companies have specific criteria regarding coverage, although at times it may seem arbitrary.  Go for a consult with a plastic surgeon and call your insurance company to find out what their criteria are.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Insurance coverage for breast reduction

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Insurance companies vary in what they cover and even individual policies within the same company can vary in coverage. So the only way to know is to ask your insurance company. Usually the best way to do this is to have a consultation with a plastic surgeon certified by the American Board of Plastic Surgery who will be able to write a letter to your insurance company to pre-authorize the procedure. And good luck to you. This is one of the procedures that makes the most difference in our patient's lives.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

Breast Reduction and Insurance Coverage?

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Based on your description you may be a good candidate for breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.

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.

Make sure you are working with a well-trained/experienced board-certified plastic surgeon.

Good luck;  prepare to be persistent when dealing with health insurance companies.

Your insurance question MUST be answered by them

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No plastic surgeon can guarantee what your insurance will or will not cover.  Many a patient has been "burned" by making an inaccurate assumption.

The safest thing to do is contact your insurance carrier and check with them.  Get names and keep good records.  Once you have your answer, then you can communicate with your plastic surgeon.

Remember, the happiest patients that come through a plastic surgeon's door are patients undergoing breast reduction:)

Good luck!

Insurance for Breast Reduction

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Each insurance contract is different so we can't give a blanket statement on this. The best thing to do is see an experienced board certified plastic surgeon for a consultation and exam and his office will be able to submit the results of the exam to your insurance compan to see if you would be covered.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 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.