Could I Pay the Portion of my Breast Reduction That my Insurance Does Not Cover?

I need a breast reduction because my breasts are weighing down my shoulder's and giving me back pains but, i wanted to know if my insurance does not cover the entire procedure could i pay the rest of the procedure out of pocket or a payment plan?

Doctor Answers 11

Insurance coverage of Breast Reduction Surgery

Thank you for your question.

From my experience, the insurance companies either "approves" the surgery (they will cover the costs) or they "deny" the surgery (will not cover any costs of the surgery).  I haven't heard of insurance company only covering certain portions of the procedure.

Best to call your insurance and ask.

Best wishes!

San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Breast Reduction Surgery

In most cases, insurance either covers the breast reduction surgery or they do not.  It is not the usual case for them to say that they will only cover a portion of the surgery.  My advice would be to call your insurance company and inquire about their criteria for breast reduction coverage.  Then you will be better informed about whether to even try having them cover the procedure.  


Good Luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Breast Reduction - Could I Pay the Portion of my Breast Reduction That my Insurance Does Not Cover?


Maybe - but it's not necessarily that simple.

There are many issues with respect to insurance (you can always pay for the surgery on your own, but that may not be necessary.  Or desirable!).  Each insurance company is different, and each has its own rules with respect to "coverage."  You'll first have to contact your company to make sure it's covered, and then you have to find a surgeon who will accept the payment the insurance company says is "usual and customary."  That may or may not be easy to do.  If you start with the surgeons who participate in the insurance company you'll be off to a good start.  If you'd rather use a different surgeon, and you have out-of-network benefits, you can contact the surgeon's office and see if he/she will accept that payment.  If that payment is not acceptable to the surgeon you want to work with, you can discuss arrangements for additional payments.

Either way, you'll need the help of a plastic surgeon to submit a letter of precertification and photos and to make sure that everything is set before you have the surgery.  You should, of course, meet with a few plastic surgeons to see what they recommend, and make sure you're informed about the procedure and its risks so that you can proceed knowledgeably.  If you do all of this you'll be most likely to have a result you'll be happy and comfortable with.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Breast reduction surgery

Insurance coverage for breast reduction has gotten tougher and tougher.  In many cases they will cover a portion of it, if and only if they initially cover it based upon their specific criteria.  Some insurance companies demand 6 months documentation of attempt of treatment of back, neck and shoulder pain, and then require a certain minimum volume of breast tissue to be removed.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Payment for breast reduction

If breast reduction surgery is approved by your insurance company, you have the option of selecting an in network surgeon  in which case your out of pocket expense will be fairly small and consist of any deductable and  copayment.  Your doctors staff will be able to tell you exactly how much that will be.  If you select a surgeon who does not participate with your insurance or one who is out of network then you will be resposible for a larger amount, that is the difference between what your insurance allows and what your doctor charges, plus  any deductable and copayment.  Some doctors can set up payment plans or refer you to a financing agency such as care credit.  Good Luck

Beverly Friedlander, MD
Short Hills Plastic Surgeon
4.8 out of 5 stars 15 reviews

Can I pay?

the answer to that question is always: yes you may.  what you work out with your surgeon is between the two of you. good luck. remember there are no absolutes, just routines that offices follow. find the doctor and office that makes your out of pocket reasonable. you paid for insurance you should try to use it.

p.s. I am not a participating physician on any plans. when a pt sees me for a breast reduction, I quote them a fee and help with submission of claim. As a courtesy,  I also look over the surgeons on their plan and point out the good doctors who are more than capable of giving them a good result. if they want to pay  me for my sevices. so be it. but I always encourage them to use insurance when thay can.

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 1 review

Breast reduction

As with most surgical procedures that are medically necessary insurance will only cover a portion. You will needn't pay the balance.

David L. Abramson, MD
New York Plastic Surgeon
4.1 out of 5 stars 12 reviews

Sort of

If the physician you use is not a participating member in your insurance, you and he will determine what you pay. In my practice, I set my fees, you pay me and we bill the insurance Company. What ever they pay, you get. Each plan is different, most will NOT tell you in advance what they will pay, and some won't even guarantee any payment. Thus, I do most reductions in my own office or to keep down your costs.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Could I pay a portion of my breast reduction?

Insurance companies either authorize and cover for your breast reduction or not . Of course you will be responsible for tha applicable co-pay or meet your deductibles .if it is not covered by your insuranse company you can finance your surgery through Care Credit or ask your plastic surgeon if they have any payment plans.

Fereydoon S. Mahjouri, MD
Minneapolis Plastic Surgeon
4.9 out of 5 stars 16 reviews

You can pay the difference between what the insurance pays and what they approve for breast reduction

Yes you can pay the deductible and the percentage that your insurance does not pay. You can pay with credit card or check or you can finance it if you have a good credit history,and usually your insurance will let you know if they approve the surgery.

Gloria de Olarte, MD
Pasadena Plastic Surgeon
3.9 out of 5 stars 10 reviews

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.