I am a 23 year old female, i am 5'4 and weigh about 133 pounds. Would Insurance Cover My Breast Reduction?
Doctor Answers 12
Will insurance cover your breast reduction?
Breast reduction insurance coverage
Breast reduction insurance coverage
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Insurance coverage for breast reduction
Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.
Insurance and Breast Reduction
Based on your measurements you seem to need a breast reduction. Getting breast reduction covered under insurance is very difficult. In fact getting them to tell you, as the consumer, the number of grams needed to get coverage will be nearly impossible. I suspect in the end it will have to be paid out of pocket. The insurance frequently places the restrictions without any medical substantiation. I have had many difficulties with my own patients getting coverage. The best way to get coverage is to call your insurance company...remember you are the consumer.
Body surface area determines reduction coverage
You are 5'4 and weigh 133 lbs, so your body surface area is 1.64 meters squared. If your insurance in with Aetna, they will require 495 grams removal. At size 34, each 100 cc's is 1 cup size change. You will have to go down 5 cup sizes to meet criteria that would end up a size A. It is most likely that your insurance company will not cover your breast reduction since you are only a 34 DD. They really do not care if you have neck, back or shoulder pain or are asymmetrical. You will NEVER meet their criteria. Your alternative is to pay cash for the procedure yourself.
Best of Luck,
Gary Horndeski, M.D.
Photos would help,a lot in evaluating your case. Insurance companies have certain criteria for covering breast reduction surgery, including symptoms as back, neck and shoulder pain. They almost always require a certain amount of breast tissue be removed from each breast, usually around 400 grams, or about a pound from each breast. You need to go through the pre-authorization process. this involves a consult with a plastic surgeon who will send a letter and photos to your insurance company.
Breast Reduction Candidate?
Thank you for the question. Based on your description, you may be an excellent candidate for breast reduction surgery. It is one of the most patient pleasing operations we perform.
The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. 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.
Make sure you're working with a well-trained/experienced board-certified plastic surgeon.
Will Insurance cover my Breast Reduction?
I encourage you to meet with a board certified plastic surgeon who accepts your insurance and see if he believes you are a good candidate, then you will have to submit his recommendations to your insurance company and see if they agree, it can be a very difficult process to gain approval , but I encourage you to try.