My Dr. Ordered 800 CC/breast. My Insurance Said It Needs to Be 1800. Is That Risky?

I think there is some miscommunication. In order to cover breast reduction surgery all insurance companies require medical record documentation of symptoms caused by large breasts like shoulder pain, skin rashes etc and a variable period of a trial of conservative therapy like support bras. Most also require that a specific amount of tissue related to body surface area be removed in order to meet medically necessary non-cosmetic criteria. In your case that would be between 800 and 820cc given your BSA of 2.14. If they are requiring the removal of such a large amount of tissue and you have a letter from them stating so you need to report that company to your state insurance regulatory agency and demand that the case be reviewed by an external reviewer.

Aside from that your BMI is 39.9 and your height weight ratio makes you morbidly obese. You should seriously consider weight loss or weight loss surgery before any body contouring surgery for health and safety reasons and to ensure a safe breast reduction surgery with less chance of complications and a more optimal result.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Thank you for the question.

Congratulations on your decision to proceed with breast reduction surgery;  this operation tends to be one of the most patient pleasing operations we perform.

You will find that every insurance company has a different  “criteria” they expect to be met (weight of breast tissue removed from each side)  in order to have the breast reduction procedure approved/covered. It will be best for you to check with your plastic surgeon whether he/she feels that  your insurance company's requirements are reasonable  and whether you will have a nice result with the required amount of breast tissue removed.

In my experience, 1800  grams is extreme;  I wonder if there has been some miscommunication and the insurance company has an 800 g requirement. Again, best to check with your plastic surgeon and/or insurance company.

Best wishes.