Is a breast reduction covered by Blue Cross Blue Shield Massachusetts?

Question

Hi I'm 25, 5'4 and approx 160lbs. I am a size 38DDD last time I was sized approx 2 yrs ago. After having my son my boobs are now even bigger and have been having pains/neck/back/headache since I developed my breasts overnight as a 13 yr old. Will they cover my surgery?

Scott C. Sattler, MD, FACS · Answer

In our experience, coverage depends on several factors - mostly dictated by your insurance company. We generally write a pre-authorization letter on behalf of patients that we believe are good candidates for the procedure. Candidacy, from the perspective of the insurance company, is usually based on height, weight, body surface area and the amount of breast tissue that can be safely removed.

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.
 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.

Josef Hadeed, MD, FACS · Answer

Different insurance companies have criteria that they review to determine whether to approve a breast reduction.  A consultation with a board certified plastic surgeon can help you to understand what your options are.  Their office will submit the necessary paperwork to the insurance company for authorization.  You may also want to check with your insurance company to see if your particular policy will cover a breast reduction.  Best wishes.

Is a breast reduction covered by Blue Cross Blue Shield Massachusetts?

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