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. It reduces breast size, allowing for better mobility and self-confidence. 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 the process to have insurance cover breast reduction and what you can expect from Dr. Widenhouse.

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, shoulder, or neck 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 their primary care physician 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 for their health insurance company.

3.  Get Pre-Approved

Many health insurance plans require pre-approval for breast reduction. 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 your plan. It is important to note that even if the surgery is pre-approved, you may still be responsible for a portion of the cost, such as co-payments, deductibles, or coinsurance. You may also need to pay for recovery materials and associated costs like pain medication, surgical bras, and more.

When Breast Reduction is NOT Covered by Insurance

There are some situations where insurance coverage for breast reduction surgery may not be available. If you’re seeking breast reduction solely for cosmetic reasons, insurance is unlikely to cover the procedure and you’ll pay out-of-pocket to your plastic surgeon. Additionally, some insurance plans may have exclusions or limitations on coverage for breast reduction surgery. If so, make sure to obtain those exclusions so you can work with Dr. Widenhouse accordingly.

Breast Reduction Surgery in Charleston, SC

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.