Will insurance pay for a breast reduction?

I'm 5'3 165 pounds & a triple D .. my breast hurt my back(I have scoliosis), my bra straps dig into my shoulders & my breast are always sore on the sides, I also have a deep indention on the side of one breast it's like my skin on my breast is stretching or something .. with all of that being said do you think heathfirst/Medicaid will pay for breast reduction?

Doctor Answers 6

Insurance

Depending on what type of insurance you have, they will pay for your breast reduction.I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with and who is a board-certified Plastic Surgeon certified by the American Board of Plastic Surgery. Best wishes! Dr. Desai
Harvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Breast Reduction covered by insurance?

Under certain circumstances Breast Reduction is covered by insurance. 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. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses

Breast reduction, some advices:

Thanks for the question.Send your photos to us to give you the advices you want and need of what procedure you need.Kind regards

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 178 reviews

Insurance Coverage for Breast Reduction

Dear Tkm1821, Whether your insurance will cover your procedure will depend on your specific contract with your insurance agency. You should call them to see if it is a covered benefit and then make an appointment with a board certified plastic surgeon. They will examine you and then can submit a prior authorization to see if you meet the insurance criteria. Good luck!

Health first breast reduction

You seem to be a good candidate for Healthfirst. Recently, that insurer added preauthorization criteria. See a participating plastic surgeon for evaluation and discussion of the process.

Will insurance pay for a breast reduction?

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. Based on your description, it sounds like you may be an excellent candidate for the procedure.  

Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, 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.  Also, prepare to be persistent when dealing with health insurance companies. I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.

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.