Breast Reduction: Will Insurance Pay for It?

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Breast reduction surgery is one of the most common procedures performed by US plastic surgeons and has been shown to be effective in reducing the symptoms and improving the quality of life for women with heavy, pendulous breasts. The American Society of Plastic Surgeons reported over 103,000 breast reduction procedures in 2013. So, if you have neck and back pain, painful shoulder grooving from bra straps, headaches and/or a rash beneath the breast area, difficulty finding appropriately fitting-clothing and difficulty exercising, you may be an excellent candidate for what is called a “medically necessary” breast reduction procedure. This procedure is often covered by most insurance companies. However, each carrier uses different criteria to determine whether your breast reduction meets their coverage guidelines.

If you are considering breast reduction surgery, you are most likely also considering the cost of the reduction. Read your insurance policy. Most insurance companies will cover “medically necessary” breast reductions. To make their coverage decision, they will look at a woman’s reported symptoms, the duration of her symptoms and how these symptoms may have affected her quality of life, along with what other treatments have been attempted to diminish or cope with the symptoms. It is important for you to discuss your concerns with your primary care physician and to have your symptoms documented in your medical record. Letters from your primary care physician, chiropractor and/or physical therapist can be invaluable in the process to obtain prior authorization for a breast reduction. This documentation, when included in a packet with a letter and pictures from your plastic surgeon, will help to facilitate providing the necessary information to obtain authorization from your insurer prior to scheduling surgery. This is an important step, because an insurance carrier may refuse to cover the costs associated with surgery if the procedure is not authorized beforehand.  

Being a good candidate for a surgical procedure also means you have a thorough understanding of the condition and the intended procedure. Breast reduction surgery is one of the most patient-pleasing procedures we perform. If you feel large breasts are interfering with your daily function, ask to visit with at least one plastic surgeon, certified by the American Board of Plastic Surgery, to learn about your options for breast reduction. Your family, your personal physician and your experienced plastic surgeon, can help you make the decisions that are right for you.

Stay tuned for our next blog on Breast Reduction: 5 Important Facts You Should Know  

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