Am I a good candidate for a breast reduction?

It's understandable that you're considering a breast reduction given the physical and psychological issues you're experiencing. Many insurance companies do cover breast reduction surgery when it is deemed medically necessary, and your symptoms could potentially qualify you for coverage. Here’s how you can improve your chances of obtaining insurance coverage:
Document Your Symptoms: Keep detailed records of your physical symptoms, including the severity of your pain, posture issues, and any skin rashes. Document how these issues impact your daily life and activities.
Medical Documentation: Obtain a letter from your primary care physician or a specialist detailing your symptoms, the impact on your quality of life, and any conservative treatments you have tried (such as physical therapy or pain management) without success.
Consult with a Board-Certified Surgeon: Schedule a consultation with a board-certified plastic surgeon who specializes in breast reduction. They can provide a thorough evaluation and help document the medical necessity of the procedure.
Insurance Criteria: Review your insurance policy to understand the specific criteria for coverage. Insurance companies often require evidence of physical symptoms and failed conservative treatments. Some policies have specific requirements regarding the amount of tissue that needs to be removed.
Submit a Pre-Authorization Request: Your surgeon's office can help you with the process of submitting a pre-authorization request to your insurance company. This request will include all necessary documentation to support the medical necessity of the breast reduction.
Follow Up: Stay in contact with your insurance company to track the status of your request and address any additional information or documentation they may require.
By carefully documenting your symptoms and working with your healthcare providers to submit a comprehensive insurance claim, you can improve your chances of obtaining coverage for your breast reduction surgery. If you have any specific questions about the process or need assistance, your surgeon's office can provide valuable guidance.

Dear srh224,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery