I'm a 40 DDD. I have pain in my back and shoulders with bruises. Would I qualify for a breast reduction through my insurance?

Question

I have lupus RA overlap syndrome. I've gained weight from the steroids to treat the illnesses, and my breast are really huge.

Peter E. Johnson, MD · Answer

This is a common question, and insurance coverage can vary widely. Chances are though you would qualify for coverage, and your surgeon will be able to submit a predetermination with your insurance to confirm.

Karol A. Gutowski, MD, FACS · Answer

Breast reduction may help. Check you insurance policy details then find a plastic surgeon in your area.

Tom J. Pousti, MD · Answer

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. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.

This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform.

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.

I'm a 40 DDD. I have pain in my back and shoulders with bruises. Would I qualify for a breast reduction through my insurance?

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More Breast Reduction Questions

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