Will United Healthcare Community Plan cover breast reduction?

Question

To start, I got 840 cc saline implants four years and seven months ago. At that time I was over 200 pounds and a DD, then got pregnant and gained more weight, 247 was most I weighed. I lost nearly 100 pounds and my breasts dropped and hurt so much. My back hurts, I experience neck pain and migraines, and am uncomfortable doing nearly all normal/daily activities. Does UHC Community Plan cover breast reduction surgery or will they? What steps do I need to take to get the surgery I need? Thank you!

Urmen Desai, MD, MPH, FACS · Answer

You will have to see a Plastic Surgeon who will need to submit this to your insurance company.   I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Keith M. Blechman, MD · Answer

Although there are some insurance plans that "cover" breast reductions it's important to understand that these plans have specific medical criteria in place for why they will cover these procedures, and there are also specific surgical techniques and requirements for how the operation needs to be done.  This may or may not fit with your expected aesthetic results.  Furthermore, you may find significant push-back by the insurance plan to cover a breast reduction if there's a breast implant already in place.  It will likely be considered a cosmetic lift, not a true reduction.A visit to a plastic surgeon's office will help you to understand if you're a candidate for the procedure, and what outcomes are realistic in your particular case.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, always schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
I'm happy to see you for a free consultation in my New York office.
Best of luck,
Keith M. Blechman, MD
New York, NY

Ben Gbulie, MD, FACS · Answer

Hi
Thanks for your question and sorry you're having this issue, yet congratulations on the weight loss.
You would have to see a PS who could seek a predetermination of coverage from UHC. I sincerely doubt they would agree to cover this since your large breasts are from having implants, not breast tissue. Either way you should see a PS who would advise you as to removal or down sizing your implants with or without a lift.
I hope this helps.....

Steven Wallach, MD · Answer

You are best to contact your insurance company to see what their criteria are for coverage before going to see a plastic surgeon for evaluation. Good luck.

Arthur Shektman, MD · Answer

You will need to contact your insurance company to see what type of coverage you have.  Although I would be surprised if they will cover this procedure, as removal of implants is not considered breast reduction.

Camille Cash, MD · Answer

Removal of breast implants is not considered a breast reduction.  When implants were placed for cosmetic reasons the removal is generally not covered by insurance.  I recommend visiting with a board certified plastic surgeon in your area to determine the removal technique that is best for you.

Robert E. Zaworski, MD (retired) · Answer

Removal of breast implants is not breast reduction surgery.  Insurance does not cover removal of implants that were placed for cosmetic reasons.

Will United Healthcare Community Plan cover breast reduction?

Answers (7)

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