OHIP covered breast reduction surgery- 2nd time around?

Question

Does OHIP (Ontario, Canada health coverage) cover a 2nd breast reduction if the first one was not successful? What are my options if I am unhappy with my breast reduction?

Larry S. Nichter, MD, MS, FACS · Answer

From your description it seems as if you are a good candidate for breast reduction. Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses

Jed H. Horowitz, MD, FACS · Answer

Each #insurance company has their own policy regarding #BreastReduction coverage. The best thing to do is schedule a visit with a plastic surgeon who can contact your insurance company for authorization after performing a #breast examination and documentation of your symptoms. You should also consider going to your primary physician for an examination and documentation as well. Insurance companies have a number of requirements and an examination will be able to determine if you are a candidate for reduction. Although some practices do not accept insurance, their staff may be able to assist you in obtaining pre-authorization. Then you can attempt to be reimbursed for out of pocket expenses.

OHIP covered breast reduction surgery- 2nd time around?

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OHIP covered breast reduction surgery- 2nd time around?

Answers (2)

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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.