Will my Insurance Likely Cover?

I have been consulting with a plastic surgeon concerning a breast reduction. After an examination he believed I was a canidate and submitted a letter of pre- authorization for the surgery to my insurance. My insurance has come back and said they do not offer prior authorization for breast reductions and that they will only consider whether or not it was necessary after the procedure is done, should I choose to have it. I am with Blue Cross and Blue Shield of Texas." I am 5.6; 165lbs, 36DDD.

Doctor Answers 2

Breast Reduction and Insurance Company Coverage?

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Congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. Unfortunately, online consultants will not be able to provide you with meaningful advice/reassurance regarding insurance coverage. Your plastic surgeon, after reviewing the specific insurance company's “requirements” regarding tissue removal, will be in a much better position to do so. He/she will know exactly where you are starting, what your goals are, and what the insurance companies requirements are.

 Best wishes.

Will Insurance Cover Breast Reduction

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See if your insurance will give you the guidelines of what they require for covering the procedure. Most have a minimum requirement of how many grams of tissue are removed. They also want documentation of what you have tried in the past to alleviate symptoms, such as physical therapy, special bras, analgesics, etc.If your insurance is through your employment or your husbands, see if your HR department will help you get the needed information. Good luck.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 81 reviews

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