Would Anthem Blue Cross qualify for breast removal/reduction?

Question

5'0, size 38DD, around 165-170 lbs. It's been years that I've had to handle this consistent issue of bad posture and constantly grabbing, scratching and picking at my own chest out of aggravation and I want as much possible removed. Would Anthem Blue Cross qualify it as medically necessary?

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided photographs.  However, the technique I recommend is The Bellesoma Method.  This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.  This technique is not covered by insurance.

Best Wishes,

Gary Horndeski, M.D.

Irena Karanetz, MD · Answer

Hi,

Thank you for the question.

Based on what you are describing, it does sound that you have large/heavy breasts causing physical symptoms, and breast reduction may be an option for you.  However, it is difficult to tell without seeing the photos and/or in person consultation.

During breast reduction surgery, excess breast tissue is removed, the breast is lifted and nipple/areola is typically made smaller.  It is easiest to think of breast reduction as including the breast lift.

Schnur Sliding Scale is a scale used by many insurance companies as a guideline for how much breast tissue should be removed in order to improve your physical symptoms.  In addition, most insurances in order to approve the surgery, will require for 2-3 letters of medical necessity (from your chiropractor, primary doctor, OBGYN, Dermatologist, etc) demonstrating that your physical symptoms due to large breasts are not improving with conservative management.

I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss  your options, specific techniques, concerns and expectations.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.

I hope this helps.
Best regards, Dr. Karanetz

Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon

Camille Cash, MD · Answer

Insurance coverage for breast reduction varies by policy.  To deem something as medically necessary may require several steps including physical therapy or other methods to improve current symptoms before surgery would be approved.  I encourage you to contact your insurance carrier for more specifics with your policy.  Even without insurance many surgeons can suggest financing options to help you.

Scott C. Lindsay, DO · Answer

Hello and thank you for your question.
Contact your insurance company to see if breast reduction surgery is a covered benefit and what the requirements are. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

Connie Hiers, MD, FACS · Answer

You need to speak to your primary care physician and get a referral to a plastic surgeon. You can then be examined and measured and a prior approval can be submitted on your behalf. Also, you can speak to your insurance company yourself and see what is covered or read your policy book.

Would Anthem Blue Cross qualify for breast removal/reduction?

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Would Anthem Blue Cross qualify for breast removal/reduction?

Answers (5)

Answer: Breast Reduction

Answer: Breast Reduction

Answer: Surgery

Answer: Surgery

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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.