Getting Blue Cross Blue Shield of LA to cover a breast reduction.

With today's insurance plans under the ACA, less and less insurance companies cover breast reduction surgery despite if you may have symptoms such as painful bra strap grooving, neck, shoulder and back pain overly large breasts. However, I suggest contacting your insurance company and asking exactly what is and isn't covered in regards to treating macromastia with a breast reduction. If  they do offer coverage then ask for a list of in network providers whom you can then contact to set up an appointment and consultation with to address your concerns.

Unfortunately many insurance companies are no longer covering breast reduction surgery even if considered medically necessary. You can try to appeal with your insurance company but your best bet would be to change to a different insurance company. good luck!

Unfortunately there is not much that can be done and I find that more and more insurance companies are excluding breast reduction from their coverage.  Even many that cover it are denying requests for coverage anyway.  But, for you, this means that you would need to cover the cost on your own if you decide to have reduction surgery while you have this insurance plan.  I've never seen an excluded procedure get covered.  However, if you think your insurance plan may change soon, perhaps you will be covered under a plan that allows for breast reduction.

Hi! I'm sorry to hear about your frustration! If your insurance is considering the procedure an exclusion there isn't much that can be done other than change to a new insurance group. Best of luck to you!

Congratulations on your significant weight loss. Based on your description of "exclusion", it is very likely that you will not be successful when it comes to obtaining your current insurance company to cover breast reduction surgery.   As you know, your option will likely include obtaining a different insurance policy  or arranging for "fee-for-service". Ultimately, key will be careful selection of plastic surgeon and careful communication of goals.Best wishes.

We encounter this quite often in our practice.   Sometimes, but not often, there are very specific exceptions to the contractual exclusion.  Blue Cross is not attempting to argue the lack of medical necessity, just that the insurance contract has specific language that excludes the procedure.  
In many of these types of cases we perform breast reduction on a cosmetic fee for service basis in our office operative suite, where the costs can be closely controlled.  Most patients find this a very acceptable alternative.
Breast reductions have an extremely high patient satisfaction rate which tends to make the exclusion less significant following surgery. Good Luck!

Hello and thank you for your excellent question. I am sorry to hear that you are having such significant issues with your breasts. Unfortunately, insurance providers are becoming more and more strict with coverage for breast reduction procedures. If they are absolutely refusing, you do not have many options beyond paying out of pocket, or changing your insurer.  Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc”

If your policy specifically has an exclusion for breast reduction there is not much you can do except change policies.  If your surgeon is willing he or she can submit photos and a letter of necessity to the insurance carrier to try to override the exclusion.  Don't be surprised if this is denied, at which time your surgeon can request a "peer-to-peer" review and, failing that, an appeal to the medical director.  Good luck, and don't get your hopes up.