FMLA coverage question for breast reduction.

I have had many patients make use of medical leave on things like breast reductions before. I have yet to have a patient denied or questioned. I can’t directly ideal to your situation but that’s been my exoerience.

Thanks for your question! Every company has different rules, protocols, etc for FMLA. I have a lot of cosmetic patients that are able to get FMLA to cover their cosmetic procedure. Talk to your employer and see what they need from you and then go from there! Good luck!

The U.S. Department of Labor’s FMLA regulations say, “conditions for which cosmetic treatments are administered (such as most treatments for acne or plastic surgery) are not ‘serious health conditions’ unless inpatient hospital care is required or unless complications develop. Discuss this with your human resources department and your plastic surgeon to determine what their experience has been with FMLA.

Dear jcash84,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for the question and every insurance company has it’s own criteria for if a breast reduction is medically necessary. You can certainly pay and bill after but it might be best to find out how much breast tissue they want removed in your case

Dr Corbin

This is often confusing to patients but FMLA and insurance coverage for any procedure, including a breast reduction, are two different things.
Healthcare insurance will pay for some or part of the operating room, anesthesia and surgeon fees as long as you meet your insurance carriers’ requirements for breast reduction surgery, which these days tends to be quite stringent.
FMLA or the Family and Medical Leave Act is a law that provides certain employees with up to 12 weeks of unpaid, job-protected leave per year. It also requires that their group health benefits be maintained during the leave. In other words, you would be eligible to have the time off, without pay as long as you qualify for FMLA and those rules are easily found on the US Department of labor site by typing “FMLA” in any search browser.
Your surgeon simply needs to fill out the FMLA paperwork and your job would be secure for the time needed to recover. Since you will not be paid for this leave it is important to seek a surgeon who uses rapid recovery so that you can get back to work quickly after your breast reduction surgery.
I have added a web reference and video that will help you with all of this.
I hope this helps. Best regards.