Could my Breast Reduction Be Covered by Insurance?

I am 5'6 and a half. About to be 20 years old. Weight 143 and breast size 34G. I have suffered from back problems sins I was 13. I now am almost crying daily because of the pain. I cant take care of my daughter that well without crying in pain. I hope I.can go to a C or D would they cover tht?

Doctor Answers 12

Insurance coverage for Breast reduction

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Your insurance should cover your breast reduction.  The amount of your benefits will depend on the quality of your policy.  Most often the insurance covers only a portion of the procedure.

Los Angeles Plastic Surgeon
4.8 out of 5 stars 62 reviews

Breast Reduction coverage

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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 and insurance

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Based on your measurements you seem to need a breast reduction. Getting breast reduction covered under insurance is very difficult. In fact, getting them to tell you, as the consumer, the number of grams needed to get coverage will be nearly impossible. I suspect in the end it will have to be paid out of pocket.  The insurance frequently places the restrictions without any medical substantiation. I have had many difficulties with my own patients getting coverage. The best way to get coverage is to call your insurance company...remember you are the consumer.

Some breast reductions are covered by insurance

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  • Many women with very large breasts suffer from neck, shoulder, and back discomfort, and even rashes under the breasts.  Some insurance companies will cover this operation depending on symptoms, the size of the breasts compared to the patient's weight, and whether or not the patient has tried any non-operative measures such as physical therapy to help with the pain.
  • Based on the information that you have provided, it is likely that some insurance carriers would cover your operation.  However, each insurance company has its own set of criteria.  Therefore, meeting with a plastic surgeon who can submit photos and other information that the insurance company will need is a great idea.
  • Best of luck to you!

Breast reduction

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Based on the info you provided I am pretty sure it will be covered.You need to see a plastic surgeon for evaluation,have him take photos and submit it to your insurance for prior approval.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 69 reviews

Insurance coverage for breast reduction surgery

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From your symptoms it would see that you are a good candidate for a breast reduction.  Since a breast reduction is performed to relieve physical pain and symptoms it is generally a covered procedure.  Next step is to be examined by a plastic surgeon.   

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Insurance for Breast Reduction

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    I would first check with your carrier to determine if they cover breast reductions.  If they do, you would likely qualify based upon your breast size, symptoms, and BMI. 

Could my Breast Reduction Be Covered by Insurance?

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The only way to get an answer to your question is to see a plastic surgeon for a consultation and if he feels you meet the physical requirements for a breast reduction, he will submit it to your insurance carrier for their evaluation.

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

Insurance coverage of Breast Reduction

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Many insurance plans will cover breast reductions, particularly for patients with documented symptoms such as you describe. Having said this, they all have varying criteria which must be met to qualify for coverage. These may include the presence of certain symptoms, a minimum amount to be removed, documentation of attempted non-surgical treatment, etc.

A qualified Plastic Surgeon should be able to help you to negotiate these issues and obtain any coverage that may apply.

Also keep in mind that, though you are likely to experience at least some releif of your back pain with a reduction, the pain may not completely resolve as it is often multifactorial.

Good luck.

Eugene J. Sidoti, Jr., MD
Scarsdale Plastic Surgeon

It Depends!

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Dear Tina, I would love to give you a simple answer of yes but I can't.  Some insurance policies do NOT cover breast reduction, plain and simple, and it is spelled out in the contract.  Others require pre-authorization and it is dependent upon a formula called the Schnur Scale.  This calculates body surface area based on your height and weight and then gives you an amount in grams that needs to be resected (removed) for insurance to consider covering it.  Most plastic surgeons will be happy to see you in consultation to discuss your options and proceed with the process on your behalf.  Look for a board certified plastic surgeon who has done a good number and can show you pictures.  Good luck, Dr. Schuster in Boca Raton

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.