Am I Too Tall For Insurance Coverage For My DDD Chest?

I am 5'11 weight is 140 breast size is 32ddd. My frame is tiny in spite of my height (5 1/2 inch wrist circ.) I also suffer with mild arthritis and early degenerative disc disease in my neck. My concern is mainly that i will get denied by bcbs of ill. Due to my height vs. My breast size?

Doctor Answers 9

Breast reduction and insurance

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Each insurance company is different in regards to authorization for breast reduction. Being that youa re 140 lbs and have very large breasts with back issues, it is very possible that they will cover this. An exam would be essential.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Insurance coverage for breast reduction

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Insurance companies take into account numerous factors when determining if a procedure is medically necessary.  The severity of your symptoms (pain, rashes, shoulder grooves, headaches), and the conservative measures you have tried (pain meds, weight loss, physical therapy, medical treatments for rashes), are much more important than your reported cup size and height.  The best way to know for sure if you are a good candidate for a breast reduction is to meet with a local board certified plastic surgeon.   

Kelly Gallego, MD, FACS
Yuba City Plastic Surgeon

Am I Too Tall For Insurance Coverage For My DDD Chest?

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Only one way to find out is to have a boarded PS send a letter of pre determination with photos and other Md notes concerning your breasts to your health insurance. 

Too Tall for Insurance to Cover a Breast Reduction

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Height and weight are only 2 of the criteria used. Insurance companies also look at pictures and symptoms. So have our plastic surgeon submit all the information and see if it gets covered. You can check the specifics with your own insurance plan.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Insurance Coverage Of Breast Reduction

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You are correct in your assumption that the charts used by insurance cos. to determine coverage of breast reduction have a bias against taller women.  However, I think your reduction would likely be covered if you are willing to have a C cup post-op.  This assumes that your insurance policy does not have an outright exclusion for reductions.

John Whitt, MD (retired)
Louisville Plastic Surgeon

You will probably get insurance coverage for breast reduction.

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I wrote this article about a year ago. I hope  you find it helpful.

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1)  Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2)  Very big reductions (like from an F cup to a C cup) will usually be covered.

3)  Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4)  Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5)  DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6)  Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7)  Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8)  Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9)  Don't give up. If the first request is denied, demand an appeal.

10)  If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Breast reduction coverage and patient height

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Unless your insurance carrier is particularly obstinant, you should not have difficulty in obtaining coverage for the procedure. Height becomes a factor only when someone who is petite seeks coverage with a bra size that would be considered within the normal range for someone of your height but is oppressive on their frame. The most significant criterion used by some insurers is body mass index, and this is to deny obese patients access to surgery, as opposed to losing weight. You do not fit into this category. Your bra size and weight are completely within insurance guidelines. Some carriers, in the past few years, have also imposed a criterion of conservative medical management, including NSAIDs and orthopedic/chiropractic treatment which, I suspect, you have already fulfilled given the nature of your neck pain. See a board certified plastic surgeon in consultation who is willing to go preauthorize the surgery on your behalf.

Insurance coverage for breast reduction

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The process for insurance coverage for breast reduction begins with a predetermination process by letter from your surgeon. For BCBS of IL your height may be the least of their concerns. Their PPO products are very restrictive and predetermination is often followed by a letter which will specify at least ten criteria, all of which must be met for consideration.

Best of luck,

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast Reduction and Insurance Coverage?

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Thank you for the question.

Congratulations on your decision to proceed with breast reduction surgery; it is one of the most patient pleasing operations we perform.

I am obviously speculating,  but I do not think that your insurance company will deny coverage of the breast reduction procedure solely because of your height/breast  size ratio.

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.

Also, make sure you're  working with a well-trained/experienced board-certified plastic surgeon.

I hope this helps.

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.