Will my medicaid insurance cover my breast reduction?

I have upper back pain, deep shoulder indents, my bra size is 42 DDD. I weight about 200 lbs and 5''5, I used to weight 215, I was told that I have to try to lose weight for my insurance to cover it. But I don't think I can lose anymore because my back is getting worst. All my weight goes to my boobs. I can't play any sports in school and I'm in my sophomore year in high school. I have a consultation march 25,2014. Men always look at me in a nasty way and I hate that. I was molested when I was younger

Doctor Answers 5

Insurance for breast reduction

Thsi  may be covered however I do not know of any plastic surgeons who will accept medicaid because they don't pay anything.Their raet oif reimbursement is embarassing to say the least.It is if I asked you to clean my house from 8am till 5 pm and pay you $10.Not a fair exchange and with increasing costs associated with practicing this will become more and more of a problem. Teh advent of Obamacare will speed thisd process up.

Fort Myers Plastic Surgeon
4.9 out of 5 stars 62 reviews


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

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

Will my medicaid insurance cover my breast reduction?

It sounds as if you have juvenile breast hypertrophy.  Certainly, if the psychologic and physical ailments that you are experiencing are troubling you, you should consider seeing a plastic surgeon for a consultation for breast reduction surgery.  Some surgeons will consider breast reduction surgery in a young woman your age, especially with the complaints that you have.  There are certain criteria that must be met in order for your insurance to cover such a procedure, given there is no specific exclusion criteria for this procedure itself.  Your symptoms certainly warrant evaluation.  Hope that this helps!  Thank you for your question!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Medicaid should cover

your procedure assuming you meet the criteria and that your estimated excisions can meet the minimums set forth by Medicaid.  You have to realize the breast growth can still occur following your procedure if done as a minor and locating a surgeon that accepts Medicaid can be challenging.  Most residency programs do accept that and is a good place to start your search. 

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Will my medicaid insurance cover my breast reduction?

I'm sorry to hear about the physical and psychosocial problems your disproportionately large breasts are causing you. 
It is probable that you are dealing with juvenile breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for your frame causing  both physical and psychological distress.

In my practice, timing of breast reduction surgery is determined on a case-by-case basis. It is NOT too early to do your homework and learn as much as possible  about  breast reduction surgery and the potential risks and complications associated with  the procedure.   

As you learn about breast reduction surgery, make sure you read about the potential risks/complications associated with the procedure. You may find the attached link helpful in this regard.  For example, 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).

On the other hand, breast reduction surgery is one of the most patient pleasing operations we perform and I think that for the right teenager (enough symptoms) it may be an excellent option (regardless of the age). Generally speaking, you will be best off undergoing the procedure once you are closer to your long-term stable weight.

Sometimes breast  reduction surgery is covered through health insurance him. 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.
 When the time is right,  seek consultation with well-trained/experienced board-certified plastic surgeons.

I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 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.