Will health insurance pay for breast reduction?

Question

If it gives you lower back pain, isn't that a legitamate reason for getting a reduction?

Answer 1

My health insurance paid for my surgery 100%. Some will pay between 50-100%. You need to state you have back pain, they will take pictures and submit it for approval. Good luck!

38J to 38C Feb 20th, 2006.

Answer 2

Plastic surgery insurance will only cover reconstructive procedures, which are those specifically designed to treat disease or trauma, and to restore malfunctions of the human body to a more normal appearance. Even in these cases (except emergencies) pre-certification is required. Most physicans’ offices will assist you with pre-certification and all will provide you with the documents necessary for coverage if, indeed, your procedure qualifies for coverage under your plastic surgery insurance claim.



While most procedures are clearly aesthetic or reconstructive in nature, there are some gray areas. For instance, breast reduction is often considered reconstructive and is thereby covered by insurance. However, in some cases, often based on the amount of tissue to be removed, standards for coverage may not be met. Furthermore, different insurance policies may request documentation of previous medical treatments, various measurements, and weight loss records before agreeing to cover the procedure. Many HMOs will not cover breast reduction at all. Hence, always get pre-certification for any potentially covered surgery so that you always know where you stand financially.

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Answer 3

Some insurance companies will take back pain as a legitimate reason for breast reduction, but sometimes not. Insurance companies are more likely to allow for breast reductions if your breasts are interfering with functioning. For example, I participated in a breast reduction for a woman who has COPD (a disorder that interferes with breathing). The woman needs to be able to breathe right and if she breathes right, this will extend her life. You might need extenuating circumstances in order for the reduction to be covered.
I guess you could tell a little lie, (or maybe these other circumstances apply to you), to your doctor and say that your breasts put a lot of extra pressure on your chest, causing shortness of breath, difficulty breathing, etc.
Or you could say that your breasts are pulling so much on your back that it is causing your to hunch, therefore reducing your lung capacity and decreasing your oxygen consumption, making it harder for you to breathe (that's quite a stretch though).
Anyway, it's the doctor who will report to your insurance company, so he/she will need to be convinced that your breasts are destroying your health and will lead to further complications. Good luck

Answer 4

only if you can prove it is causing back or neck problems which most surgeons will be happy to supply a statement of that point i had one done 4 years ago insurance paid about half i wasnt having any problems at the time other than i was 5 foot tall 123 pounds and was a d cup which looked freakish on my frame

Answer 5

that is tricky. some pay for it for that reason, others do not. the trick to the game is all on how your doctor writes it up to the insurance company.

Answer 6

yes, just stress the fact that you are getting back pain and you're good to go

Answer 7

your doc has to say it's medically necessary.

Answer 8

i think they will if it is health related.