Breast reduction from 36H to 36C. Will UnitedHealthCare cover without any documentation?

Question

I'm 5'10" , weigh 195lbs and wear a size 36H. I have deep grooves on my shoulders, back and shoulder pain, along with daily headaches. I've also been struggling with yeast infections beneath both breasts for the last month. I really would love to go back to a 36C, which I used to be prior to having kids, to be more comfortable and pain free. Unfortunately, so far I have no doctor documentation. What are the chances of getting UnitedHealthCare to cover the procedure? Is my goal even realistic?

Hampton A. Howell, MD · Answer

When trying to get a breast reduction covered by insurance it is almost always helpful and sometimes necessary to have supporting documentation from another physician or mid-level provider that you see (who is not the surgeon evaluating you for a possible breast reduction).  It would be good to go ahead and make an appointment with your primary care provider and discuss your concerns regarding all of the symptoms that you mentioned so that can be documented in your medical record.  You can go ahead and make an appointment with a board-certified plastic surgeon as well to evaluate you, go over the nature of a breast reduction, risks, benefits, etc.  I would be happy to see you in consultation.   My office works with United Health Care on a regular basis.Take care,Dr. Howell

Steven Wallach, MD · Answer

You need to first find out what your insurance companies criteria are for covering a reduction, then you will have to go for a consultation.

Paul J. Leahy, MD · Answer

Hello. You sound like a potentially very good candidate for breast reduction surgery. For insurance coverage, however, documentation and examination is mandatory. Just schedule a consultation with a local plastic surgeon, and he/she will take it from there. Good luck!

Breast reduction from 36H to 36C. Will UnitedHealthCare cover without any documentation?

Answers (3)