Steps to Breast Reduction Approval from Insurance UHC Choice Plus?

I'm 18, 5'2 & 180lbs. My breasts are 36in G/H cup. I have grooves in my shoulders, numbness in my arms and back, persistent neck pain, and headaches. They hinder my activities and cause problems in my daily life. I can't afford the high cost of the surgery so I need to be approved by the insurance. I need to know the steps to be approved. The pain is steadily getting worse and the longer I have large breasts my back gets worse. Will it be considered a preventative surgery? Thanks fo any help!

Doctor Answers 3

Breast Reduction and Insurance Coverage?

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Based on your description you may be a good candidate for breast reduction surgery; It is one of the most patient pleasing operations we perform. If you are not at your long-term stable weight, it will be in your best interest to drop weight prior to surgery.

As  you think  about  breast reduction surgery make sure you do your homework and understand the potential risks and complications associated with  the procedure.  Unsatisfactory scarring is  one of the potential complications. Make sure you also understands that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. 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. Make sure you're saying a well-trained/experienced board-certified plastic surgeon.  

Prepare to be persistent.

Best wishes.

Breast reduction and insurance

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Each insurance company handles approvals for breast reduction differently.  Your surgeon's office may help you facilitate this. If you want to explore this on your own, you can call your insurance company and find out their requirements for approval.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast Reduction Insurance Coverage

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First of all, beware that some insurance policies have outright exclusions for coverage of breast reductions.  Others vary in the things you need to do for coverage.  Many require failure of chiropractics, PT, etc. in relieving symptoms.  All require certain weights of tissue to be removed proportional to your BSA.

John Whitt, MD (retired)
Louisville Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.