If I Want to Reduce and Lift my 38 F Size Bra to 38 C is Insurance Bc/ Bs Cover It?

If I Want to Reduce and Lift my 38 F Size Bra to 38 C is Insurance Bc/ Bs Cover It?

Doctor Answers 6

Breast Reduction Insurance Coverage Factors

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Insurance Criteria for Breast Reduction Varies between Companies but going from an F to a C cup would most likely qualify for the minimum weight of breast removal.
Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company. Contact your individual company and request their specific Criteria.
Insurance company favors approval for patient with functional problems like the ones you mentioned - back, neck and knee problems, bad posture, inability to  run , etc.
The more Physician recommendations for breast reduction the better - that would include your gynecologist, primary care doctor, plastic surgeon, chiropractor, etc.
Your plastic surgeon will then contact your insurance company for preauthorization.
Here is some general information however to help you :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 though insurance criteria are becoming more and more restrictive.

Insurance coverage and breast reduction surgery

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Every year is is harder to get insurance to cover breast reduction procedures.  This is true even with significant reductions of several cup sizes.  Based on your description, it is certainly worth a try.


One thing that many patients don't realize, is that within a big insurance company in a given geographic area, there may be hundreds of different plans, each with different rules.


You need to obtain the specific rules that pertain to your particular plan and follow them to the letter.  Sometimes the plans erect a variety of hurdles, such as requiring physical therapy for many months, before they will consider approval.  Persistence and supporting letters from primary care physicians can be helpful.


You need to be actively involved in the process.  From the insurance company's perspective, you, not the doctor, are the customer, so you are the one who needs to put pressure on the person reviewing your information.  If you happen to work for a larger company with an employee benefits coordinator, these people can sometimes be valuable allies in the process.


Best of luck.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Breast reduction and insurance coverage

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Based on your description this is very likely. Breast reduction will include a breast lift. After you have had an examination and if your surgeon feels this is a medically necessary procedure, he or she will contact you insurance company to get preuthorization for insurance coverage.

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 112 reviews

Breast reduction

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Each insurance company will have different criteria to approve breast reductions.  This may include medical notes from treating physicians for back and neck pain, your surgeon's notes, photos, and estimates of breast weight removal.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast reduction coverage

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Insurance criteria take into account your height, weight, conservative medical management, underlying complaints and other factors. If you have BC/BS of NJ, know that they are particularly strict, especially about medical management for up to one year and weight within 10% of their standard, which is based on 1950s calculations. You should be able to review the insurance criteria online and then to ascertain whether you have fulfilled the requirements.

Breast Reduction and Insurance Coverage?

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Based on the description of breast size you may be an excellent candidate for breast reduction surgery. If you are not at a long-term stable weight, it will be in your best interest to achieve this before undergoing breast reduction surgery.

Whether or not the breast reduction procedure is covered by your insurance company will depend on the specific insurance company and your policy. You will need to check with them directly.

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. Make sure you're saying a well-trained/experienced board-certified plastic surgeon. 

When dealing with insurance companies prepare to be persistent;  and keep in mind that breast reduction surgery is one of the most patient pleasing operations we perform.

Best wishes.

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.