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The Truth About Breast Reduction and Insurance

Author: Burt Faibisoff, M.D., FRCS (C)

With recent changes in healthcare, many women have asked if insurance covers breast reduction. This is a complicated question. I can tell you upfront that whether or not your breast reduction is covered by insurance will depend on your healthcare provider. But, there are a few things you should know about breast reduction and insurance coverage…

#1 The bigger the reduction, the more likely it will be covered.

Breast reduction is more likely to be covered by insurance when there is an obvious opportunity for symptomatic relief. For example, if the breast reduction would relieve back and shoulder pain, then the insurance company is more likely to pay for it. While you and I know that your reduction would provide relief, proving it to the insurance company is more difficult. As such, bigger reductions (F cup to C cup or E cup to B cup) are more likely to be covered by insurance.

At the same time, some women will decide to get more of a reduction than they actually want in order to get the breast reduction covered by insurance. I understand that everyone’s financial situation is different; however, I strongly advise against getting more of a reduction than you want for yourself, as you will ultimately be dissatisfied.

#2 It is your surgeon’s responsibility to gather the evidence.

If you go ahead and have surgery without documenting pain and discomfort, then you might have a difficult time getting reimbursed. It is your surgeon’s responsibility to document your pre-surgery condition in writing. Gather as much information as possible, including a second physician’s opinion, before undergoing surgery.

#3 Prepare to get turned down.

There are so many reasons why insurance companies won’t cover breast reduction surgery. Oftentimes, the reasons may seem unfair. For example, your insurance company may require you to go through a weight loss or physical therapy program – even if you are already at your desired weight. Don’t give up! You may have to jump through some hoops with your insurance provider in order to become eligible.

To find out if you’re a candidate for breast reduction surgery, take our online assessment. Call 480-257-2670 for more information.
Please consult with your physician before undertaking any form of medical treatment or adopting any exercise program or dietary guidelines.

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