Will my Humana insurance cover a breast reduction?

Question

I'm 5'O, have 3 kids, my cup size is 38dd. My back hurts constantly. My posture is bad I slump over most the time when I walk.

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

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

Kenneth Hughes, MD · Answer

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

Susan D. Vasko, MD, FACS · Answer

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.

Daniel Barrett, MD · Answer

Dear brysonsmommy,it would be the easiest to check it with your insurance. Based on your description, you would be a great candidate for a breast reduction. I would suggest you to consult with a board-certified plastic surgeon.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

Tom J. Pousti, MD · Answer

Based on your description of symptoms, you seem to be an excellent candidate for breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, 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. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. Also, prepare to be persistent when dealing with health insurance companies.   
In regards to the outcome of the breast reduction surgery, the most important decision you make will be careful selection of your plastic surgeon. I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.
Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. ***Ask to SEE lots of examples of their work AND preferably speak/see patients who have had similar procedures done.
I hope this, and the attached link, helps. Best wishes.

Will my Humana insurance cover a breast reduction?

Answers (7)

Answer: Breast reduction

Answer: Breast reduction

Answer: Will my insurance cover a breast reduction?

Answer: Will my insurance cover a breast reduction?

Recommended reading

Everything you need to know about Breast Reduction

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

Will my Humana insurance cover a breast reduction?

Answers (7)

Answer: Breast reduction

Answer: Breast reduction

Answer: Will my insurance cover a breast reduction?

Answer: Will my insurance cover a breast reduction?

Browse related questions

Recommended reading

Everything you need to know about Breast Reduction

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