How do I get my insurance to pay for a breast reduction? I'm currently a 42h; back pain is unbelievable. I'm only 200lbs & 5"3.

I have horrible endurtures migraines and low back pain and sciatica

Doctor Answers 5

How do I get my insurance to pay for a breast reduction? I'm currently a 42h; back pain is unbelievable. I'm only 200lbs & 5"3.

Insurance companies differ in their guidelines, but in general they want documentation of your symptoms by your doctor for a period of 3-6 months, depending on your policy, and documentation of conservative management such as weight reduction, gait training, physical therapy, nonsteroidal anti-inflammatories (e.g. Ibuprophen).  If you check out my previous answers I have addressed this question in more detail many times.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

Insurance and Breast Reduction

Your first step would be to find a board certified plastic surgeon that accepts your insurance. Once you met with him/her, they would take some measurements and photos to send off to your insurance company. Then you just wait to see if they would approve you. Chances are they will have you try weight loss first due to your BMI being so high. Also, plan on having some out of pocket costs to you such as your deductible and possibly other fees. Your physicians office should be able to give you an idea, if approved, of what you may be responsible for financially.

Lawrence Bundrick, MD
Huntsville Plastic Surgeon
5.0 out of 5 stars 7 reviews

Breast reduction

At your height, and with that weight, your BM I is 35. That's pretty high. Most insurance companies won't cover overweight patients until they try and lose weight first. But the only way to know for sure is to see a plastic surgeon who does breast reduction, have him examine you, and communicate with your insurance company to see if they will cover you.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Insurance and breast reduction

You need to contact your insurance company and check their criteria for approval of a breast reduction first. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast reduction by insurance

Unfortunately you can't get insurance to pay for breast reduction if you don't meet their requirements which may include height and weight requirements, and whether or not your insurance even covers breast reduction.  Speak with your plastic surgeon and your insurance agent to find out what the requirements are for your particular situation.

Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 6 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.