Will Anthem Blue Cross Blue Shield cover a breast reduction?

I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon
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The criteria for insurance coverage of breast reductions varies depending on the insurance company, and on the specific insurance plans within that company. Generally, the acceptance of coverage depends on a combination of symptoms, and removal of a certain amount of weight that is determined based on the weight of the patient. If enough breast weight is removed, then it is deemed that the surgery is being performed for a legitimate medical purpose, since that removed weight can improve symptoms. If very little breast tissue is removed, then the surgery is really more of a lift. From your descriptions, it seems that you would likely qualify for coverage. Good luck!

Hello and thank you for your question
Contact your insurance company to find out if this surgery is a covered benefit for you and what the criteria is. Schedule a consult with a board certified plastic surgeon to discuss your options. Best wishes!

Hi, based upon your symptoms you have listed as well as your size, it sounds appropriate to be evaluated for a breast reduction.  Yes, insurance covers breast reductions.  Once you are evaluated by a board certified plastic surgeon, your medical history and exam will be sent to the insurance company for approval before your surgery.  Certain criteria have to be met before insurance will approve a surgery.  It also can be based upon your specific insurance plan.   Good luck, you will feel much better after your reduction.Dr. Wright

Dear gwendolynd89,based on your description, it sounds like you might be a good candidate for a breast reduction surgery. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

You will need to contact your insurance company to find out if your policy covers breast reduction and if so what are the requirements to get pre-authorization. Insurance companies have many different policies, some may cover where others may not. Good luck!

Breast reduction surgery has significant health benefits for anyone who suffers due to their breast size. However, acquiring insurance coverage is very complicated, most likely to purposely limit the amount of payments toward this surgery. First, you need to contact your insurance carrier. They will tell you this is a covered benefit, however there are always limitations to the coverage. As long as you are talking to the right (experienced/knowledgeable) person they should be able to give you a list of requirements, such as doctor's letter, years of PT, documented weight loss, amount of tissue required, covered facilities, covered physicians, amount of coverage, etc. Additionally, you should find out how much it will cost you even with your insurance benefit. The vast majority of my patients self pay for breast reduction because after all of these calculations, it's not worth it to them.

Dear Gwendolyn,Hello and thank you for your excellent question.  If you are interested in having your insurance cover your breast reduction, you should contact them directly to see if 1) this surgery will be covered, and 2) under what conditions. You should be evaluated for a No-Vertical-Scar breast reduction technique. There are a number of no-vertical scar breast lift techniques, but my preferred technique is the Bellesoma Breast Lift technique. Our technique provides an exceptional breast lift, upper pole fullness, relief from neck and back pain, and no vertical breast lift scar. It uses a woman’s OWN breast tissue to produce an internal suspension technique, without the need for a breast implant. It does not disturb the nipple, areola, or breast glands, so sensation and the ability to lactate is preserved. It uses 3D scanning of your breasts and body to design a procedure specifically designed for YOU, and you alone. Finally, for patients who desire breast enlargement, it can be combined with fat grafting. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

RealSelf100

America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 – 2018

BeautyAdvisor Top Contributor

You sound like you would certainly benefit from a breast reduction. There is only one way to find out if you qualify for insurance coverage - see a surgeon in consultation and have the surgeon contact the carrier.