In order for your insurance company to authorize a breast reduction, meaning that they will pay a large percentage of the cost, there has to be proof of a viable need for the surgery. This information by no means covers all insurance companies. Some qualifications differ from company to company. Most of all, you’ll need to find out from your insurance company what their requirements are. This list, though, should be a starting point for you to be able to determine if your insurance company is likely to cover costs of breast reduction for you. If most of these statements ring true for you, you have a good chance of being covered by your insurance company.
1. Have you been to the doctor several times over (at least) the past year due to back, shoulder, or neck pain? Are you consistently prescribed medication to help you deal with the pain? There will need to be documentation from your general practitioner that shows you are dealing with pain that is caused by large breasts.
2. Have you lost weight? Some insurance companies will require the patient, if they are overweight, to lose a certain number of pounds before they will consider covering a breast reduction. This is because in some instances (not all), when weight is lost, breasts will lose fat as well.
3. Do you have constant red groove marks on your shoulders where your bra sets? This is a discomfort that many with large breasts have to put up with on a daily basis.
4. Do you get a frequent rash under your breasts? This rash is caused by a combination of heat, sweat, and skin rubbing skin as large breasts keep an almost constant contact with the skin underneath.
5. Do your breasts hang low, resembling sacks containing bowling balls? Additionally, do you have stretch marks around the tops of your breasts where the skin has been stretched under the weight of them? Do your nipples point toward the ground instead of facing forward like they should?
6. Your insurance company will also need to determine whether a certain amount can be removed from each breast (in most cases at least a 1/2 pound each) before they will authorize a breast reduction surgery.
If you are unsure about whether you might qualify, all you have to do is make an appointment to consult with a plastic surgeon which will likely only require a co-pay. Your plastic surgeon’s office has the means to send your insurance company the records and files they need to determine if you can be covered.
For more information on breast reduction surgery in upcoming articles (from what to expect at the consult to preparing for and caring for after surgery), click here to go to my article catalog. Click “Follow” at the top of the page near my profile picture and confirm. You can then receive notification of my articles as I publish them. Your information will be kept private and you will not be spammed.
Sources: Personal Experience, BellaOnline