How do I get my insurance to pay for my breast reduction?

Okay I already asked a question. But I have another question about the insurance process of getting a breast reduction covered. How would I go about that? Would I need to go to the doctor so much complaining about headaches and neck and shoulder pain? Or go to a plastic surgeon and have them send something in? I'm just a little confused on how to go about it. Also I have BCBS

Doctor Answers 5

How do I get my insurance to pay for my breast reduction?

Congratulations on your decision to proceed with breast reduction surgery;  It is one of the most patient pleasing operations we perform. 
As you think about breast reduction surgery make sure you do your homework and understand the potential risks and complications associated with the procedure. Unsatisfactory scarring is one of the potential complications. Make sure you also understands that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you seeking consultation with well-trained/experienced board-certified plastic surgeons.
Prepare to be persistent.
Best wishes.

Insurance coverage for breast reduction

Complaining is a start but won't fulfill the criteria. Check the Blue across website. All the criteria and rules are online. These include BMI, minimum gram weight resection, orthopedic and conservative management prerequisites. Once you have met them and have records, then see a plastic surgeon. It isn't just a matter of sending in a letter anymore. 

Insurance and BR

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive.

Insurance and breast reduction

It is best to check with your insurance company regarding what criteria they have for breast reduction. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Breast reduction

Breast reduction surgery can be covered by insurance and you need to contact your insurance to find out the details of coverage. There is usually a process that involves sending in photographs and notes so try discussing with your insurance, primary care doctor and board certified plastic surgeon. Best of luck, MMT

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.