How to Get a Breast Reduction Covered by Insurance

Breast reduction surgery can be a life-changing procedure for women who suffer from the physical and emotional discomfort of large breasts. However, the cost of the surgery can be a barrier for many patients. Fortunately, some health insurance plans may cover breast reduction surgery if certain criteria are met. Below, we’ll discuss how to get a breast reduction covered by insurance.

1.  Meet the Criteria

To be eligible for insurance coverage of a breast reduction, patients must meet certain criteria. Insurance companies typically require that the patient’s symptoms are severe enough to qualify as a medical necessity. This may include chronic back, neck, or shoulder pain, skin irritation, or breathing problems caused by the weight of the breasts. The patient’s bra size and weight of the breasts may also be considered. Typically, insurance companies require that a certain amount of breast tissue be removed to qualify for coverage.

2.  Get Documentation

To have a better chance of getting insurance coverage for breast reduction surgery, patients should provide detailed documentation of their symptoms and medical history. This may include medical records, photographs, and letters from healthcare providers that document the patient’s symptoms and the impact they have on their daily life. Patients should also keep a record of all their visits with their healthcare providers.

3.  Get Pre-Approved

Before undergoing breast reduction surgery, patients should seek pre-approval from their insurance company. This involves submitting a request for coverage and supporting documentation to the insurance company. The insurance company will review the request and determine if the surgery is medically necessary and covered under the patient’s plan. It is important to note that even if the surgery is pre-approved, the patient may still be responsible for a portion of the cost, such as co-payments, deductibles, or coinsurance.

When Breast Reduction is NOT Covered by Insurance

There are some situations where insurance coverage for breast reduction surgery may not be available. If the patient is seeking breast reduction solely for cosmetic reasons, insurance is unlikely to cover the procedure. Additionally, some insurance plans may have exclusions or limitations on coverage for breast reduction surgery.

Fortunately, in the event that you are not covered by insurance for your breast reduction procedure, there are other options you can consider. At Port City Plastic Surgery, we offer various financing options to make your treatment more affordable. During your consultation, we can help you determine your coverage for breast reduction surgery and explain the financing options that could be most beneficial to you. Contact us today to schedule your consultation with Dr. Widenhouse and get started today.