Does Fedelis health insurance pay for breast reductions?

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. 

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
#breastreduction#reduction

This is an excellent question for you to consider asking Fidelis directly, since no surgeon on this site work for an insurance carrier as far as I know.

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.

Hello and thank you for your excellent question. You should call your insurer to see if they cover this procedure. If you have a high-deductible plan, it may cost the same to pay for the procedure out of pocket, as opposed to having your insurer cover it. Any treatment plan should be based on a detailed discussion with equal input from both you and your surgeon.    Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon.  Good luck!  
Best,
Jon Ver Halen, MD FACS 

Harvard educated plastic surgeon