I'm 5'5'' and 170lbs with 38HH breasts. Will my insurance (selecthealth) cover the cost of a breast reduction??

Question

22 years old, 5'5'', around 170lbs & am a 38HH ( but keep growing). Bad pressure inmy ribcage & PAIN when I try to run. Don't get to work outbecause of the pain. Also extremely sensitive. If sleep on mystomach, my breasts squish my lungs. Weight on them hrts. Get more neck pain the bigger they get/back pain if i have to bend over. Skin underneath/between stretches/itches/chafes. Don't have much $$ to spend. Can I qualify for my insurance to pay for a reduction? I have SelectHealth. Please Help!!

Jed H. Horowitz, MD, FACS · Answer

Thank you for your question. I'm sorry you are experiencing such difficulties. Every #insurance company has their
own policy regarding #reduction coverage. The best thing to do is schedule a
visit with a plastic surgeon who can contact your insurance company for
authorization after performing a #breast examination and #documentation of your
symptoms. You should also consider going to your # primary #physician for an
examination and documentation as well. Insurance companies have a number of
requirements and an examination will be able to determine if you are a
candidate for reduction. Best wishes!

Tom J. Pousti, MD · Answer

I am sorry to hear about the problems your disproportionately large breasts have caused.  Breast reduction tends to be one of the most patient pleasing operations we perform.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. 
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.

Best wishes with your breast reduction procedure; hopefully you will be very pleased with the outcome of the procedure performed.

Nelson Castillo, MD · Answer

Thank you for your questions. Based on your narrative you appear to be a good candidate for a breast reduction.  If you have insurance, the first step would be to check with your carrier to see if breast reduction surgery is covered by your plan. If it is, then see an ASPS board certified plastic surgeon for an in-person evaluation and discussion of breast reductions. They can submit paperwork on your behalf to see if you are approved.  If you have paperwork that demonstrates your bad back, neck pain, and rashes from your family doctor, gynecologist, or chiropractor this would help in your claim. Hope this helps.

Lawrence Bundrick, MD (retired) · Answer

This is a great question, but one specifically for your insurance company. There are a lot of insurances out there that will cover breast reduction surgery. I would contact them directly and then find a board certified plastic surgeon that accepts your insurance to proceed. Best of luck to you.

Sherwood Baxt, MD (retired) · Answer

Let's say you've gone through the whole process and your insurance will either not cover or only very partially cover the operation. Here's an alternative. Find a local BCPS Who specializes in the liposuction only operation. Even though it's far from perfect it may be a reasonable alternative and compromise for you and certainly much less expensive if you have to pay yourself.

I'm 5'5'' and 170lbs with 38HH breasts. Will my insurance (selecthealth) cover the cost of a breast reduction??

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I'm 5'5'' and 170lbs with 38HH breasts. Will my insurance (selecthealth) cover the cost of a breast reduction??

Answers (5)

Answer: Breast Reduction and Insurance

Answer: Breast Reduction and Insurance

Answer: Scarless breast reduction

Answer: Scarless breast reduction

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.