Will medicaid cover my breast reduction? I live in NY.

Question

I'm a 21 year old with 32F breasts, this is the smallest they've been and they're in the process of getting bigger again. I've always had back pains, they started when I was about 13 when I was a D cup and it got progressively worse over the years. It almost feels as if I have two huge weights on my chest, it's ruined my posture and I can't stand for too long or else my back starts having pain. I also use to be very athletic when but now I can't run, jump or exercise without my chest hurting.

Sheila S. Nazarian, MD · Answer

It is possible that medicaid will cover your breast surgery if you meet their criteria.  Have your plastic surgeon submit it to them and see if they approve.

Sugene Kim, MD, FACS · Answer

Breast reduction may or may not be covered depending on your insurance 
carrier and your breast size.  Please check your insurance policy to see
 whether breast reduction is a covered procedure.  Often times, 
insurance company will dictate how much breast tissue to be removed. 
 Please visit an experiences, board-certified plastic surgeon to learn 
about the procedure, its cons and pros, benefits, and alternatives. 
 Please contact your insurance carrier to learn about inclusion and 
exclusion criteria.  Best wishes.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problems your disproportionately large breasts cause. Based on your description, you certainly sound like a good candidate for breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.Medicaid has been known to cover breast reduction surgery. For multiple reasons,  most plastic surgeons that I know of to not work with Medicaid. I think finding a reputable plastic surgeon who will work with Medicaid may be the challenge you will face.Best wishes.

Robert L. Kraft, MD, FACS · Answer

Patients on Medicaid typically have one of a number of HMOs and the decision would depend upon your carrier.  All have preauthorization requirements and criteria.  See your primary care physician for a referral and take it from there.  HealthFirst and Fidelis are good about covering breast reductions. Other insurers make life more difficult. Best of luck!

Will medicaid cover my breast reduction? I live in NY.

Answers (4)

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