Will Blue Cross Blue Shield cover a breast reduction in AZ?

Question

I am 5'4", weight about 150 and my breast size is a 36 DD, almost a 38. My neck and back are constantly in pain

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

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.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problems you are experiencing secondary to breast hypertrophy; based on your description you may be an excellent candidate for breast reduction surgery at some point. It will be in your best interests, for several reasons, to achieve a lower/stable long-term weight prior to proceeding. “Official” recommendations of course would necessitate in-person consultation.Breast reduction surgery is one of the most patient pleasing operations we perform. By removing “excess” breast tissue, adipose tissue, and breast skin this operation reduces AND lifts the breasts to a higher position on the chest wall (in other words, the breasts are "automatically" lifted when a breast reduction is performed). By doing so, patients often find improvement in neck, back, and shoulder discomfort and find it easier to form their activities of daily living and exercise.Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Obtaining insurance coverage for breast reduction surgery will likely involve 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 letters/pictures from your plastic surgeon will help you obtain authorization. Prepare to be persistent when dealing with health insurance companies.When the time is right, seek consultation with well-trained/experienced board-certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.I hope this, and the attached link, helps. Best wishes as you work towards your goals.

Jed H. Horowitz, MD, FACS · Answer

Each insurance company has their own policy regarding #reduction 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 seeing 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.

Arun Rao, MD · Answer

Thank you for your question. Most insurance plans do cover breast reductions as long as certain criteria are met. Your surgeon will submit their office notes and will likely have to provide photo documentation of your breast to be reviewed by BCBS. Your insurance company has 90 days to respond to an authorization. Based on your description you sound like you would be a great candidate for a breast reduction. Feel free to contact our office, we can have you come into our office for a consultation and give you a better idea if your insurance would cover your reduction. Best of luck.

Elliot Hirsch, MD · Answer

Hi, Insurance coverage of breast reductions depends on the insurance 
payer and their criteria.  Criteria usually include the amount of tissue
 to be removed based on your height and weight and your symptoms and how
 they were managed.  Good luck!

Will Blue Cross Blue Shield cover a breast reduction in AZ?

Answers (6)

Answer: Breast reduction

Answer: Breast reduction

Answer: Insurance coverage of breast reductions

Answer: Insurance coverage of breast reductions

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.

Will Blue Cross Blue Shield cover a breast reduction in AZ?

Answers (6)

Answer: Breast reduction

Answer: Breast reduction

Answer: Insurance coverage of breast reductions

Answer: Insurance coverage of breast reductions

Browse related questions

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.