Will my Insurance Cover Breast Reduction Surgery? (photo)

i have atena insurance & was wondering if they would cover the cost of a breast reduction? im 21 years old, 5ft even & weigh between 150-160lbs. i am a 40D. i have always had a large chest and it has always given me problems such as sever lower/upper back pain, shoulder pain, shoulder grooves, neck pain, rashes under my breast and on my shoulder. i slouch a lot and it is hard for me to sit up straight because the weight of my breast is pulling me down. i also am now eating healthy & working out

Doctor Answers 10

Will my Insurance Cover Breast Reduction Surgery? (photo)

Thank you for inquiring about insurance coverage and breast reduction.  Insurance companies have different guidelines for covering BR.  Even within the same company guidelines vary from one policy to the other.  However, what they are looking for is not just the cup size because this is arbitrary and differs from one manufacturer to the other.  They are looking for symptoms such as the ones you indicated and how long you have had them, and this has to be documented by your doctor not just stated by yourself.  Hopefully you are under the care of a Board-Certified plastic surgeon with expertise in this area who can guide you in the right direction.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

Insurance coverage for breast reduction is unpredictable.

Insurance companies have different criteria for coverage of breast reduction if they cover it at all. This will be worked out after a visit with your plastic surgeon and a review of your insurance policy. You can call your broker on your own.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Will Insurance Cover Breast Reduction

Years ago the standard criteria for an insurance company to cover breast reduction surgery was that a minimum of 500g (grams) of tissue was needed to be removed from each breast.  Since that time insurance companies, in an effort to avoid paying for the surgery, have changed and added criteria.  Now, most companies require a specific amount of tissue removed based on the patient's height and weight.  They also often need documentation that you have seen your general physician on at least two separate occasions for neck, shoulder and back pain related to the breasts, reports from physical therapists that you have undergone PT for issues related to large breasts, chiropractic notes, etc.  The list can go on and on.  And even with a "predetermination" this doesn't guarantee that they will pay for the procedure when it's done.  Good luck.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 33 reviews

Will my Insurance Cover Breast Reduction Surgery?

It depends upon which Aetna plan you have and a pre determination letter from a participating PS in that plan. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Will Insurance Cover Breast Reduction?

I think you may be borderline, as most insurance companies require that a minimum of 500 grams of breast tissue needs to be removed from each breast, and usually that equates to a DD cup. Each insurance company sets their own requirements, your best bet is to see a Board Certified Plastic Surgeon who specializes in breast surgery to see if you may be a candidate.Good luck!

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 75 reviews

Breast Reduction Candidate?

Thank you for the question and picture.
 Based on your description, I think you may be an excellent candidate for breast reduction surgery; it tends to be 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. 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.

Sometimes breast  reduction surgery is covered through health insurance. The best way to obtain insurance coverage for breast reduction surgery involves 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 letter/pictures from your plastic surgeon will help you obtain authorization.
 When the time is right,  seek consultation with well-trained/experienced board-certified plastic surgeons.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Insurance coverage for a breast reduction

A consultation with a plastic surgeon will be needed to determine your medical eligibility for a breast reduction.  From your description is sounds like you are a good candidate.   

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Reduction covered by insurance

requires that your reduction meets weight minimums to qualify as an insurance covered case.  You need to see a local surgeon who can help you navigate the maze of getting authorization.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Will my Insurance Cover Breast Reduction Surgery?

Insurance companies have different criteria for approving breast reduction surgery.

Most require at least 500 grams of breast tissue to be removed from each breast. If you are having  symptoms  such as you have , direct conference with  the medical consultant for the insurance company is often beneficial

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Breast reduction and insurnace coverage

Without an exam in person it is difficult to say if you are a good candidate. I will say that insurance companies are getting more difficult to deal with in terms of coverage and you should check with them regarding thier criteria to approve the surgery.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.