How likely is it that my insurance would cover breast reduction surgery and how do I go about getting approval?

Question

I am 5'3 3/4" tall and weigh roughly 150lbs. I am currently wearing a 30FF bra size. I have grooves in my shoulders and my bra cuts in underneath my breasts. I have a very difficult time finding bras I can wear because of the difference between the band and cup size and have to special order them as they don't carry this size in any store I have come across. I want to have surgery but I don't know what I would need to do to get approval from my insurance company. (I have Highmark BCBS, if that helps.)

Tom J. Pousti, MD · Answer

Based on your description and pictures you may be a great candidate for breast reduction surgery; it is one of the most patient pleasing operations we perform. If you are not at your long-term stable weight, it will be in your best interest to drop weight prior to surgery.As  you think  about  breast reduction surgery make sure you do your homework and understand the potential risks and complications associated with  the procedure.  Unsatisfactory scarring is  one of the potential complications. Make sure you also understands that further surgery may be necessary in the future (for example if the breasts were to grow in size again).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 seek consultation with well-trained/experienced board-certified plastic surgeons.  Best wishes.

Miguel Delgado, MD · Answer

It is very possible that you would be covered for breast reduction surgery. But it depends on your policy, some insurances exclude breast reduction. You can either call your insurance and ask what their requirements are or seek out a Board Certified Plastic Surgeon that specializes in breast surgery to help you get authorization. Most insurance companies will want documentation of what you have tried so far, such as: physical therapy, analgesics, special bras etc. Having documentation of everything you have tried will help your surgeon get approval. Good luck!

Rick Rosen, MD · Answer

Thank you for your questions. I believe you are a good candidate for the procedure. Each insurance company is different. Some require up to 6 months of physical therapy to strengthen your back and shoulder muscles and "save" you from the surgery. I would recommend you seek out a board certified plastic surgeon in your area that performs this regularly.

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How likely is it that my insurance would cover breast reduction surgery and how do I go about getting approval?

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