Is it possible for my insurance to pay for my breast reduction and my tummy tuck in same surgery?

Question

I suffer from back and shoulder pain from my 38G/F breast and I frequently suffer cuts on my shoulders from some of my bras . Plus I have eczema and depending on my day can suffer sweat breakouts that leave my skin underneath extremely irritated. I understand that the Tummy Tuck is considered cosmetic and I would have to pay for it, but is it possible for the two surgeries to be combined to only have to go under once and save myself time and money?

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  Yes you can have a breast reduction and tummy tuck performed in the same operation with some of the costs of the aesthetic abdominoplasty costs offset by the insurance coverage of the reduction.  Be sure to see an ASPS board certified plastic surgeon in consultation to discuss.

Miguel Delgado, MD · Answer

If your insurance approves your breast reduction, you can include cosmetic procedures as well. The operative report will have the needed information to separate cosmetic from medically necessary procedures. Good luck.

Kenneth Hughes, MD · Answer

None of us can predict the decisions insurance companies will make regarding coverage for BR surgery or what documentation will sway their decision. BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) 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 symptoms, lack of previous medical management, and lack of enough tissue that should be removed.  Obtain a pre-authorization or predetermination of benefits from your insurance company to discuss with your PS. The BR and TT can be combined in the same surgery; however, even if medical insurance funds the BR surgery, many PSs are unable to cover the costs of the surgery with their low reimbursement rates. Because the TT is considered a cosmetic procedure, you will be responsible for paying for it in full prior to the surgery.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Mahlon Kerr, MD, FACS · Answer

In some cases this is definitely possible. Even if your surgeon does not accept insurance that doesn’t mean your insurance provider won’t reimburse you for part of of the reduction. I would visit with a few PS in your area to learn more. Good luck!!

Joshua Kreithen, MD · Answer

To quickly answer your question: yes!  If it very plausible to have an insurance based breast reduction and the cosmetic abdominoplasty at the same time.  Depending on your surgeon, this combo surgery could take anywhere from 4-6 hours.  I would recommend postoperatively to stay overnight in a hospital or around the clock nursing care for appropriate aftercare.  Good luck and hope this helps!

Susan D. Vasko, MD, FACS · Answer

Thank you for your question. Yes, it is possible to have your insurance breast reduction and cosmetic abdominoplasty done at the same time. Your surgeon will bill insurance for the breast reduction, and your abdominoplasty will be paid out of pocket, generally prior to your surgery. Many patient choose to combine these surgeries so they only have to go under anesthesia one time, and only have one recovery. Good luck.

Ruth Celestin, MD · Answer

Hello, that is a great question and the answer is YES you can combine "medically necessary" procedures such as a breast reduction with cosmetic or "self-pay" procedures such as abdominoplasty.  This is something I do quite often and it does not affect your likelihood of getting pre-authorization for the breast reduction from your insurance company.  Consult with a board certified plastic surgeon who is very comfortable and efficient with combination surgery for your safety and so that you are not over-paying on anesthesia and OR time.Best of luck to you!

Aldo Guerra, MD · Answer

It's possible your insurance could cover your breast reduction and you may have to pay out of pocket for the tummy tuck. Always see at least 3 plastic surgeons before moving forward with surgery.Best wishes. Dr. ALDO

Scott D. Green, MD · Answer

Thanks for your question. Yes, it is possible to combine the surgeries and have one paid for by insurance and the other paid for by you. However, I would discuss this with your surgeon and/or his office to ensure that the proper codes and protocol is taken. It can be tricky but it certainly is possible.
Good Luck!

Jack Peterson, MD · Answer

Yes, it is definitely  an option to combine these procedures. Speak with your Board certified plastic surgeon about the recovery period and post operative care.In my practice, you pay for the tummy tuck and we bill insurance for the breast reduction if it has been pre-approved by your insurance carrier.

Is it possible for my insurance to pay for my breast reduction and my tummy tuck in same surgery?

Answers (16)

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