Will my Humana insurance cover a breast reduction?

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

Breast reductions which are medically necessary i.e. you suffer back, shoulder, and neck pain with documented medical attention are typically covered by medical insurance. If not, your insurance company may try to deny you based upon a lot of things such as weight, lack of enough tissue that should be removed, lack of symptoms, and lack of previous medical management.Read Humana's certificate of coverage. Determine what medical information is required for them to provide a preauthorization or predetermination of benefits.  Seek consultation with a board certified plastic surgeon who can evaluate your medical condition and assist you with obtaining a predetermination of benefits.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Thank you for your question. In order to accurately assess the amount of breast tissue which needs to be removed in order to reach your desired cup size, my best advice to you is to schedule a personal consultation with a board-certified plastic surgeon. Please also be advised that if you are interested in trying to have your Breast Reduction surgery covered and paid for by your health insurance company, many plans actually require that a predetermined minimum number of grams be removed based on your Body Surface Area - (height and weight) - NOT your BMI. Additionally, many insurance companies require written documentation of months or years of conservative treatment (medical care, supportive garments, NSAIDS or prescription medications, massage therapy or chiropractic treatment, powders for rashes, etc.) before they will pre-authorize coverage and payment for a Breast Reduction procedure.