My bra size is 34 g. I am 5'7" and weigh 155 pounds. Based on the schnur scale I would have to have 440 grams removed for insurance to cover. Would I qualify for a breast reduction? Would I have that much tissue to remove? I have been told my breasts are very dense. Does that make a difference?
February 16, 2016
Answer: When does insurance cover a breast reduction To qualify for breast reduction surgery to be covered by your insurance, you have to meet a number of requirements. Having large breasts alone doesn't matter. They will only consider covering breast reduction surgery in patients who are suffering medically due to the large breasts. They want to know what symptoms you have suffered due to the large breasts, how long you have had the symptoms, what measures you took to try to alleviate or lessen those symptoms, and how long you tried those conservative measures. They often ask for photos to document the large breasts, and occasionally will also request documentation that supports what you say you have tried for treatment. For example, if you have tried prescription creams or ointments for rashes below the breasts, they may ask for the doctors record of that treatment. Once you pass all of those requirements, they will want to know how much tissue the surgeons estimates will be removed. While we can estimate the amount to be removed, if the amount that is actually removed in surgery falls short of that estimate, then insurance can deny payment. Actually, even if you meet every single criteria, your insurance may deny payment. At our office, we try to help our patients by submitting to the insurance company for preauthorization, and even if the preauthorization is granted, each preauthorization letter has one sentence at the bottom- saying that just because they authorized the surgery does not mean they will pay for it. Funny, right? The actual criteria and rules do vary from insurance plan to plan, and you can usually find out exactly what the criteria are if you google your insurance company and their coverage for breast reductions. To answer your question about dense breasts- this may make a difference in how much the tissue that is removed weighs. The fattier the breast tissue the less it weighs, whereas more dense breasts tend to have more fibrous tissue which would typically weight a little more. If figuring this out seems to daunting to do on your own, start by seeing a board certified plastic surgeon who has experience doing breast reductions and dealing with insurance (not all plastic surgeons take insurance). They can guide you through the process, and tell you if you have a good chance at getting the procedure covered. I would also recommend asking the surgeon what his/her policy is if you have the procedure and insurance denies payment. You want to know your costs up front in all scenarios, so that there are no surprises. Good luck!
Helpful
February 16, 2016
Answer: When does insurance cover a breast reduction To qualify for breast reduction surgery to be covered by your insurance, you have to meet a number of requirements. Having large breasts alone doesn't matter. They will only consider covering breast reduction surgery in patients who are suffering medically due to the large breasts. They want to know what symptoms you have suffered due to the large breasts, how long you have had the symptoms, what measures you took to try to alleviate or lessen those symptoms, and how long you tried those conservative measures. They often ask for photos to document the large breasts, and occasionally will also request documentation that supports what you say you have tried for treatment. For example, if you have tried prescription creams or ointments for rashes below the breasts, they may ask for the doctors record of that treatment. Once you pass all of those requirements, they will want to know how much tissue the surgeons estimates will be removed. While we can estimate the amount to be removed, if the amount that is actually removed in surgery falls short of that estimate, then insurance can deny payment. Actually, even if you meet every single criteria, your insurance may deny payment. At our office, we try to help our patients by submitting to the insurance company for preauthorization, and even if the preauthorization is granted, each preauthorization letter has one sentence at the bottom- saying that just because they authorized the surgery does not mean they will pay for it. Funny, right? The actual criteria and rules do vary from insurance plan to plan, and you can usually find out exactly what the criteria are if you google your insurance company and their coverage for breast reductions. To answer your question about dense breasts- this may make a difference in how much the tissue that is removed weighs. The fattier the breast tissue the less it weighs, whereas more dense breasts tend to have more fibrous tissue which would typically weight a little more. If figuring this out seems to daunting to do on your own, start by seeing a board certified plastic surgeon who has experience doing breast reductions and dealing with insurance (not all plastic surgeons take insurance). They can guide you through the process, and tell you if you have a good chance at getting the procedure covered. I would also recommend asking the surgeon what his/her policy is if you have the procedure and insurance denies payment. You want to know your costs up front in all scenarios, so that there are no surprises. Good luck!
Helpful
February 18, 2016
Answer: Breast reduction / insurance coverage Based on the measurements provided, you may be a good candidate for breast reduction surgery. Typically insurance companies require that this surgery only be done in cases of back pain, neck pain, shoulder pain, shoulder grooving, rashes beneath the breasts that don't respond to topical medications, etc. Usually 400-500g removal is required but this varies between insurers. That typically equates to 2 cup sizes for most women. Discuss this with you board certified plastic surgeon and your insurance company to determine if this is the case for you. Best wishes!--Erik Hoy, MD
Helpful
February 18, 2016
Answer: Breast reduction / insurance coverage Based on the measurements provided, you may be a good candidate for breast reduction surgery. Typically insurance companies require that this surgery only be done in cases of back pain, neck pain, shoulder pain, shoulder grooving, rashes beneath the breasts that don't respond to topical medications, etc. Usually 400-500g removal is required but this varies between insurers. That typically equates to 2 cup sizes for most women. Discuss this with you board certified plastic surgeon and your insurance company to determine if this is the case for you. Best wishes!--Erik Hoy, MD
Helpful
