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

Question

So I have BCBS of LA and understand that a breast reduction is considered an "exclusion" from all policies. I don't quite understand this since it is just as much a medical necessity as a lot of things covered. I had the gastric sleeve a few years ago (also not covered by BCBS) and have lost a little over 80lbs. Even before then, my breasts bothered me. I'm in a 36F, I have the indentions in my shoulders, hump on my back & problems. Is there anything that can be done to get coverage?

Randal Haworth, MD, FACS · Answer

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.

Miguel Delgado, MD · Answer

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!

Tom J. Pousti, MD · Answer

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.

Jennifer Lauren Crawford, MD · Answer

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.

Scott C. Lindsay, DO · Answer

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!

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

Answers (8)

Answer: Exclusion of breast reduction

Answer: Exclusion of breast reduction

Answer: BBR insurance coverage

Answer: BBR insurance coverage

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Everything you need to know about Breast Reduction

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

Answers (8)

Answer: Exclusion of breast reduction

Answer: Exclusion of breast reduction

Answer: BBR insurance coverage

Answer: BBR insurance coverage

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.