22 doctors weighed in:

Does insurance usually cover breast reductions? My breasts are so large that they cause me severe back pain. I believe breast reduction surgery would help with this - but is it something insurance companies cover?

22 doctors weighed in
Dr. Jason Lichten
Surgery - Plastics
5 doctors agree

In brief: Depends

The factors that go into deciding whether your insurance company will pay for breast reduction include the language and exclusions in your plan, how much breast tissue will be removed, what symptoms you are having from your large breasts, how much you weigh and what you have tried to alleviate the symptoms you are having.

In brief: Depends

The factors that go into deciding whether your insurance company will pay for breast reduction include the language and exclusions in your plan, how much breast tissue will be removed, what symptoms you are having from your large breasts, how much you weigh and what you have tried to alleviate the symptoms you are having.
Dr. Jason Lichten
Dr. Jason Lichten
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2 comments
Dr. Douglas Linville II
Great proof if benefit would be calluses on your shoulders from bra digging in. I haven't had problems justifying for patients with this.
Dr. Douglas Linville II
Great proof if benefit would be calluses on your shoulders from bra digging in. I haven't had problems justifying for patients with this.
Dr. John Walker
Surgery - Plastics
5 doctors agree

In brief: They should

Insurance companies will try and not pay, but can be "motivated" by diligent work to prove it would help.
Photographic documentation of size, shoulder grooving, along with a letter from a surgeon will help. Symptoms like shoulder grooving and upper back pain (between shoulder blades), are helped by reduction surgery. You should also not be too overweight, or they will simply tell you to slim.

In brief: They should

Insurance companies will try and not pay, but can be "motivated" by diligent work to prove it would help.
Photographic documentation of size, shoulder grooving, along with a letter from a surgeon will help. Symptoms like shoulder grooving and upper back pain (between shoulder blades), are helped by reduction surgery. You should also not be too overweight, or they will simply tell you to slim.
Dr. John Walker
Dr. John Walker
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1 comment
Dr. Joseph Mele
Breast reduction has a proven track record for reducing, and even eliminating the symptoms caused by large breasts. Despite it effectiveness, some insurance companies have stopped trying to deny coverage for breast reduction, and now just exclude it from their covered procedures.
Dr. Subramaniam Arumugam
Surgery - Plastics
3 doctors agree

In brief: Sometimes - yes

Some insurance companies in their policy state that breast reduction is not a covered surgery.
For those who cover > you need documentations, letters and you must get pre approval.

In brief: Sometimes - yes

Some insurance companies in their policy state that breast reduction is not a covered surgery.
For those who cover > you need documentations, letters and you must get pre approval.
Dr. Subramaniam Arumugam
Dr. Subramaniam Arumugam
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Dr. Harold Rosenfeld
Surgery - Plastics
3 doctors agree

In brief: It DEpends

With ropper documentation, you may be covered talk to your carrier.

In brief: It DEpends

With ropper documentation, you may be covered talk to your carrier.
Dr. Harold Rosenfeld
Dr. Harold Rosenfeld
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Dr. Gregory Surfield
Surgery - Plastics
1 doctor agrees

In brief: Sometimes

You need to check with your insurance regarding your benefits, but generally most insurances will cover breast reduction surgery if it is medically indicated.

In brief: Sometimes

You need to check with your insurance regarding your benefits, but generally most insurances will cover breast reduction surgery if it is medically indicated.
Dr. Gregory Surfield
Dr. Gregory Surfield
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Dr. Francisco Agullo
Surgery - Plastics
1 doctor agrees

In brief: Most of the time

It seems like you might be a candidate for breast reduction.
With proper documentation it might be covered. You r plastic surgeon will submit photos and a report to your insurance company to determine if it will be covered.

In brief: Most of the time

It seems like you might be a candidate for breast reduction.
With proper documentation it might be covered. You r plastic surgeon will submit photos and a report to your insurance company to determine if it will be covered.
Dr. Francisco Agullo
Dr. Francisco Agullo
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Dr. Daniel Downey
Surgery - Plastics
1 doctor agrees

In brief: Hello,

Hello, insurance companies are generally reasonable about working with you to preauthorize breast reduction.
First, partner with your primary care doctor to document your chronic pain. Next, make sure you are at or close to your ideal body weight. Document with your primary care doctor all the non-surgical things you have tried to lessen your pain, like massage, chiropractic, acupuncture, and physical therapy. Then meet with a plastic surgeon to learn about the operation and to see if your plastic surgeon agrees that this operation will be beneficial for you. With his/her advocacy and your pre-work, you may be able to obtain an approval from your insurance company. Dan downey md facs downey plastic surgery seattle, wa, usa.

In brief: Hello,

Hello, insurance companies are generally reasonable about working with you to preauthorize breast reduction.
First, partner with your primary care doctor to document your chronic pain. Next, make sure you are at or close to your ideal body weight. Document with your primary care doctor all the non-surgical things you have tried to lessen your pain, like massage, chiropractic, acupuncture, and physical therapy. Then meet with a plastic surgeon to learn about the operation and to see if your plastic surgeon agrees that this operation will be beneficial for you. With his/her advocacy and your pre-work, you may be able to obtain an approval from your insurance company. Dan downey md facs downey plastic surgery seattle, wa, usa.
Dr. Daniel Downey
Dr. Daniel Downey
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