Does medicaid cover Breast reductions? (photos)

Question

I have medicaid. And was wondering if I may be qualified for a breast reductions bc it's painful on my back and neck.

Larry S. Nichter, MD, MS, FACS · Answer

Unfortunately, each insurance company has their own criteria including Medicaid. 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#smallerbreasts

Bhupesh Vasisht, MD · Answer

The short answer is typically no.  Medicaid thinks this is a cosmetic procedure.  What I recommend is that you start with your primary care doctor.  You need to establish that the large breasts are causing your back and neck pain.  This means seeing several specialist to rule out other causes of back and neck pain.  Also to determine how much volume of breast tissue needs to be removed to improve your pain.  This can be done with a plastic surgeon.  However, in my experience medicaid does not cover this procedure. Good luckDr VasishtSouth Shore Plastic Surgery

Does medicaid cover Breast reductions? (photos)

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Does medicaid cover Breast reductions? (photos)

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Everything you need to know about Breast Reduction

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