Breast Reduction Insurance Coverage
Breast reduction surgery is generally covered by most insurance plans. According to the American Society of Plastic Surgeons, breast reduction is regarded as a reconstructive surgery to relieve medical symptoms. Because of this, most insurance companies will provide coverage for the surgery as long as the patient meets certain conditions.
Medical History
Plastic surgeons will write a letter to the insurance company requesting coverage for the breast reduction procedure. In order to have a greater chance of approval, several criteria must be met. If the plastic surgeon can show a medical history of visits to medical practitioners for symptoms related to the weight and size of the breast, there is a higher chance of obtaining approval.
Demonstration of Inteference
The patient needs to be able to demonstrate how the size and weight of the breasts are interfering with normal functioning. While many women will note cosmetic reasons, this is not enough of a reason for the surgery to be covered. Medical reasons such as back pain, inability to exercise, headaches related to tension in neck and back and indentations in the shoulders can all show a need for the surgery.
Amount of Tissue Removed
While this can vary from one insurance company to the next, most insurance companies will require that a minimum of 500 grams be removed from each breast during surgery. Based on the detailed measurements taken by the plastic surgeon during the consultation, an estimation of how much will be removed will be made based on the woman's body type and stature.
Appropriate Weight
Some insurance companies will also require the patient be at the appropriate weight for her height and frame size before the surgery occurs. This is to ensure that the excess size and weight of the breasts is not due to excess overall weight for the patient. However, if documentation can be provided that even at a lower weight, the patient still had large breasts, this requirement may be waived.
Picture Documentation
The plastic surgeon will take pictures of the upper half of the patient's body during the examination. These pictures are usually from the front, both sides and the back. Not only do these show the size of the breasts in relation to the woman's frame, they can also highlight permanent shoulder indentations due to bra straps and poor posture due to the weight of the breasts.
Considerations
While breast reduction surgery is generally covered by most insurance companies, the requirements can vary greatly among companies. It is important to choose a plastic surgeon who not only has a long history of successful breast reduction surgeries, but who has also learned to navigate the insurance maze to assist patients in getting approved for the surgery.
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