What is the procedure if a patient self pays for breast reduction surgery vs. insurance coverage?

No difference in procedure or lack of consideration of your goals should vary based upon whether you or the insurance company is "footing the bill". You will have to be approved for the BR from your PCP and/or other physicians who are caring for your health.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

in my practice when paying out of pocket for a reduction as the reduction fees are extremely high for the procedure and insurance never pays that much.  If your surgeon is wanting to charge the full insurance fee for a reduction, you can find better prices if you make phone calls to surrounding surgeons.  The procedure takes up to 3 hours in most surgeon's hands.   And you don't have to do anything except your surgeon's confirmation that you are a good candidate for this procedure... and you can choose how much tissue is removed and what is left behind.

In spite of major efforts to advocate for our patients, there are are some insurance companies that will not cover breast reduction, or it is excluded from your policy. When that is the case, the procedure can be done through cash pay, like a cosmetic procedure. You are then responsible for the surgery cost, anesthesia cost, and operating room cost. Aside from how you pay, the procedure and its indications are the same. A statement from your PCP is usually not needed, unless you need to be medically cleared to show you are healthy and safe for surgery. Your plastic surgeon should be able to guide you through the process. Best wishes for great functional relief and great result.

The procedure itself does not change regardless of how its costs are managed. Many patients undergo 'cosmetic' breast reduction for improved aesthetics similar to a breast lift. Each insurance plan is different, and many have exclusions for breast reduction surgery. This is unfortunate, because this procedure often affords many functional benefits that go beyond the positive of a much better breast shape. As with any elective procedure, you will have to meet standard health criteria for surgery. A mammogram is often recommended if you are 40 years or older, have significant risk factors, or a strong family history of breast cancer. Even as a 'cosmetic' reduction, I strongly recommend that patients send the removed breast tissue for examination by a pathologist. Insurances will sometimes cover this expense, even if the procedure itself was not approved. 

Self pay eliminates all the hoops for breast reduction. All you need is the best plastic surgeon, see them and be cleared by them for surgery, and proceed to get this done. Usually the very top plastic surgeons aren't taking insurance anymore (because the reimbursement is so very low) so you will probably get a better result by not using insurance. 

Thanks for the question. This has become a common problem as the insurance companies make it harder and harder for their clients to qualify for this procedure. More than half of our Breast Reduction patients pay out of pocket for their operation. In that case we have standard fees and like, cosmetic surgery, the patients pays ahead of time and the fees cover the surgeon, the anesthesiologist and the surgical suite. When you speak to Plastic Surgeons who perform Breast Reduction, they will pretty much all agree these are some of the happiest patients they have. The surgery can dramatically reduce the physical discomfort they are experiencing as well as making sports and exercise activities more comfortable, finding clothing easier, and eliminating the inappropriate attention and comments some complain about. Our patients schedule a full consultation and examination and can then schedule the surgery at a time of their convenience. It is performed in our private and licensed surgical facility with a board certified anesthesiologist in attendance. Hope this helps.