Does Fedelis health insurance pay for breast reductions?

Fidelis does cover breast reductions.  There are two versions of this coverage: one is a Medicaid/Affordable Care Act product and the other is applicable as EPO coverage. It is possible for Fidelis to have deductibles on some policies.  It has preauthorization criteria in terms of height/weight/bra size, BMI, and conservative management that must be fulfilled but is more liberal than some other carriers.

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive
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The first step is to contact Fidelis to go over your insurance plan and ask if they can give you a list of surgeons that take this insurance.