What is the Criteria for a Breast Reduction to Be Medically Necessary?

You will find that coverage of the procedure varies widely from one insurance policy to the next.  Insurance companies look primarily at the volume to be removed and that the patient has not gotten relief with conservative nonsurgical treatments.  Many insurance companies will cover if you have 500 grams of excess breast tissue (about 1 lb) per side and rarely some may
cover as low as 350 grams. However some companies may require a kilo or more.
 This being said before you go forward with surgical procedures the insurance company may
want you to see your primary care physician to see if they have any other recommendations and such as therapy or medications. Many neck and back pain symptoms can be treated very successfully with
strengthening of the spinal supporting musculature.  This requires some
time and effort but may provide a lifetime of benefit.  
Insurance companies usually want to see a record of having been treated by nonsurgical methods for
at least six months and not getting improvement with conservative treatments.
 This usually means that you have tried diet and exercise, medications and
possibly therapy or chiropractic and have not gotten adequate relief.  The next thing to
do is get an exam with a board certified plastic surgeon with a good
reputation. He should be able to perform an exam to tell exactly how much
excess breast tissue you have.  Then the surgeon will write a letter to the insurance company
and see if they will give approval for the surgery. The insurance company will
send both you and your provider a letter with their decision within a few weeks
in most cases.  Many patients are able to get insurance coverage for the
procedure, but if you do not qualify many places offer a significant reduction
in the price for out of pocket cases that are paid in advance.  
I usually expect that patient will get a significant reduction in their upper back and neck pain symptoms. I hope to get an improvement of 20-80% relief of their pain.  However, some patients get complete relief and some get very little change.  If you find that your symptoms are mediated by wearing a really good supportive bra then I think you have a chance at a higher level of improvement in your symptoms.  Best of
luck on your journey

Each breast reduction patient is unique and responds differently to the surgery. Some experience massive relief after only a modest reduction, while others require more tissue be removed to alleviate back and shoulder pain. Proportionately sized breasts shouldn't cause physical problems, so any sort of back, neck, shoulder, or even head pain that can be linked to breast size is cause to at least consider a reduction. Additionally, different insurance plans use different guidelines for approval. Most require documentation of physical symptoms as well as a certain amount of tissue to be removed, based on the patient's height and weight. 

Breast reduction: back problems#Breastreduction is very successful in reducing these problems.Candidates for Breast
Reduction surgery are women who wish to have smaller breasts to
achieve a more proportional appearance or to alleviate physical discomfort.
Breast reduction can correct symptoms from excessively large, heavy breasts
that may cause the inability to do certain exercises, or create back, shoulder
and neck pain, poor posture, bra-strap shoulder indentations and chafing or
rashes under the breasts