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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?

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

Doctor Answers 4

Would I qualify for a breast reduction through my insurance?

November 3rd, 2016
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It is hard to predict how individual insurance companies will answer, but it is very likely that you could get approved.  Go see a local plastic surgeon and learn about the process, and specifically how your lupus and steroid use will affect your surgery.  Best of luck!

Dr. Jespersen

Web reference: https://drjespersen.com/procedure/breast-reconstruction/

M. Renee Jespersen, MD
November 3rd, 2016

Would I qualify for a breast reduction through my insurance?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is hard to predict how individual insurance companies will answer, but it is very likely that you could get approved.  Go see a local plastic surgeon and learn about the process, and specifically how your lupus and steroid use will affect your surgery.  Best of luck!

Dr. Jespersen

Learn more: https://drjespersen.com/procedure/breast-reconstruction/

M. Renee Jespersen, MD

Would I qualify for a breast reduction through my insurance?

November 3rd, 2016
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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.

Web reference: http://peterejohnsonmd.com/breast-enhancement/breast-reduction/

Peter E. Johnson, MD
November 3rd, 2016

Would I qualify for a breast reduction through my insurance?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Learn more: http://peterejohnsonmd.com/breast-enhancement/breast-reduction/

Peter E. Johnson, MD

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?

November 3rd, 2016
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Breast reduction may help. Check you insurance policy details then find a plastic surgeon in your area. 

Karol A. Gutowski, MD, FACS
November 3rd, 2016

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?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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

Karol A. Gutowski, MD, FACS

Would I qualify for a breast reduction through my insurance?

November 3rd, 2016
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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.

Web reference: http://www.poustiplasticsurgery.com/Procedures/Procedure_breastReduction.htm

Tom J. Pousti, MD, FACS
November 3rd, 2016

Would I qualify for a breast reduction through my insurance?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Learn more: http://www.poustiplasticsurgery.com/Procedures/Procedure_breastReduction.htm

Tom J. Pousti, MD, FACS

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.