Insurance Coverage for Breast Reduction

Breast reduction surgery is often covered by insurance carriers, but not all of them cover this procedure and significant restrictions may exist. Some insurance companies actually exclude breast reduction as a contract exclusion. When insurance carriers cover breast reduction, they may have specific criteria that must be met.

For instance, most insurance carriers require documentation of symptoms. Examples would include back pain, shoulder pain, breast pain, and headaches to name a few. They may also require documentation of attempted non-surgical management of symptoms. Examples might include physical therapy, support devices, and anti-inflammatory drugs. Some insurance carriers require a minimal amount of breast tissue removal from each breast. This is often based on calculations, which utilize the patient’s weight and height.

The process starts with a consultation. At that time, pictures are taken and a prior authorization letter is sent for approval. It typically takes about six weeks to obtain a response. If your insurance carrier’s criteria are met, you are ready to schedule surgery. In our experience, breast reduction surgery has some of the highest satisfactions rates seen in plastic surgery.