Breast Reduction: Info, Prices, Photos, Reviews, Q&A

Most Insurance Companies will NOT pay to correct a Breast Asymmetry

To have any reasonable hope that your insurance company will pay for anything, that medical condition MUST be stipulated in writing as a “covered benefit” in your contract with the insurer. If it is not on the contract, you / your employer did not/are not paying for that coverage and the insurer is not legally obligated to pay for it REGARDLESS of how important it may be to you.

In addition, all surgeons can tell you that even if you do have a condition which IS a “covered benefit”, all insurers will request that your surgery be cleared with them (“pre-certified”) and permitted (Preauthorized”), if the surgeon is to have a hope of collecting a penny.

As regards your obligations, you will find out that NO policy (with the exception of rare union policies) exempt you from paying part of the cost. By the time you are done paying your Co-Payment and Deductible, your surgery is FAR from being solely the insurance company’s problem.

Lastly, no insurance company will knowingly pay for Cosmetic Surgery – surgery NOT intended to save lives or improve function but solely intended to improve appearance.

Having a large asymmetry between your breasts is unfair and distressing but hardly qualifies as something any insurer I am familiar with would consider paying to correct. (Peter A. Aldea, MD, Memphis Plastic Surgeon)

Insurance criteria for medically necessity is changing almost daily and becoming extremely rigid, so you would be well advised to read the fine print of your policy. My experience mirrors the other consultants. Insurance will not usually cover breast reduction until a solid case has been submitted, documenting

1. musculoskeletal (neck, shoulder, back pain) treated by primary care, orthopedic, chiropractors, etc;
2. skin rashes treated by dermatologists;
3. failure of conservative therapy (i.e. massage therapy, wearing supportive bras, weight reduction) to reduce and/or relieve the first two “functional” problems.

In some cases, the insurance company will scrutinize your Body Mass Index and link payment on the condition that an extraordinary weight of tissue be removed.

One large busted patient’s preauthorization stipulated 750gm/side as a condition of payment. She had specific ideas, which I concurred with about how large and shapely her breasts should be.

Since her desire to retain a full volume which is proportionate to her curvy frame, she bypassed insurance and paid for the procedure herself.

In these days of Health Care Reform, many Plastic surgery procedures which have both cosmetic and reconstructive aspects are probably going to be scrutinized and eliminated as covered benefits. (Lavinia K. Chong, MD, Orange County Plastic Surgeon)

Insurance commonly covers reduction of very large, heavy breasts

Insurance companies differ, but they commonly cover reduction of very large, heavy breasts that cause back, neck and shoulder pain. Such surgery is quite common and a great relief to many patients.

A variety of treatment options are available for breast asymmetry including reduction, augmentation, or lifts done differently on each breast. When we treat such a condition in our practice, insurance payment is usually not involved. (Sutton Graham II, MD, Greenville Plastic Surgeon)

If the large breast is causing you a problem such as back pain, etc. you might be able to make the case for them to cover reduction on that side.

You will probably need letters from an orthopedic or neurologist documenting that the large breast is creating a medical problem for you. Call around to plastic surgeons in your area and see if any have an insurance consultant. This person could help you with this. (Tracy Pfeifer, MD, Manhattan Plastic Surgeon)

Insurance coverage for breast reduction surgery

Insurance coverage for your surgery depends entirely on your policy. Some insurance policies specifically exclude breast reduction whereas others will allow it after a medical clearance or an additional valuation by a orthopedist, physical therapist, or even a chiropractor.

Your best course of action is to visit with a board-certified plastic surgeon and receiving evaluation. Your plastic surgeon will then examine you, review your surgical options, obtain photographs and send a letter for authorization to your insurance company.

The insurance company will then inform you and your surgeon if the procedure is covered. (Pat Pazmino, MD, FACS, Miami Plastic Surgeon)

Cosmetic breast procedures are not covered by insurance

Unless you have a functional problem related to your breast size (neck pain, back pain, skin issues etc) its unlikely an insurance company would fund a procedure that is designed to restore symmetry to your breasts.

This is a cosmetic procedure designed to enhance your appearance. Seek out a board certified plastic surgeon for a consultation and price quote for this cosmetic procedure. (Scott C. Sattler, MD, FACS, Seattle Plastic Surgeon)

If you just have asymmetry more than likely the insurance company will not cover your procedure. If you have a congenital deformity like Poland’s syndrome they might. (Steven Wallach, MD, New York Plastic Surgeon)

No insurance won’t cover it

I do many reviews for insurance companies for both breast reduction and breast asymmetry. The reality is that your insurance company doesn’t care that you have a debilitating breast abnormality. Your insurance company is only concerned about making money so the less they pay to physicians for surgery the more they keep and pay to their stockholders.

So my vast experience is that they will not pay for your surgery. Save up the money, get the opinion of several surgeons and proceed with a surgery that is on your terms not your insurance company’s. (Christopher L. Hess, MD, Fairfax Plastic Surgeon)

Every insurance company is different

Every insurance company is different. The only similarity is that they all try to deny and delay so they do not have to pay for anything. However, if you have a significant asymmetry, the it is worth pursuing insurance coverage for the procedure. (David Shafer, MD, New York Plastic Surgeon)

Depends on the insurance company

Coverage for breast asymmetry without any symptoms of back and neck pain or other functional disability will likely not be a covered benefit for most insurance companies. However, all insurance companies have different criteria and it really depends on your specific plan.

Almost all, however, will consider this a cosmetic procedure and will not be a covered benefit. You can get a consult with a board certified plastic surgeon to go over your question in more detail after a full evaluation. (Bahram Ghaderi, MD, Chicago Plastic Surgeon)

Medical insurance for diseases, not asymmetries

sMedical insurance is designed to treat diseases, not assymetries. In my experience, it is not right to try and bill an assymetry in the same manner as say large breasts.

Large breasts can cause back pain, breast pain, notching of the shoulders, rashes under the breasts. All of these things can make a woman suffer miserably. We should not attempt to use money designed for this problem for something that is only emotionally troubling–unless your insurance company covers emotional issues with breast assymetry. (Robert M. Freund, MD, New York Plastic Surgeon)