Will (state) insurance pay? Under what conditions do your breasts need to be? A certain size.. how do they decide? Are there other options for financial help if it can't?
2007-12-20 09:15:55 · 7 answers · asked by Anonymous in Health ➔ Women's Health
I am afraid I do not know the answers to all of your questions, but I will tell you what I do know.
Some insurance companies will pay for breast reduction. I know two women who have had the surgery, and both were covered fully by their insurance companies. My guess would be that not all insurance companies will cover it, but as stated above, I know that some do.
I don't know if state insurance will cover the surgery. You might want to call if you are covered on a state plan and talk to someone about whether or not you would be covered.
The women who had reductions which were covered both had, obviously, large breasts, but the reason they were covered is because their breasts were starting to create curvature in their spines. One of them was a DD cup, and the other was slightly larger, but both had been having pain in their back, neck and shoulders for quite some time before they sought help from a doctor. It is interesting to note that neither one of them knew that the pain was coming from having to support large breasts. They both assumed they had developed some sort of back problems. I know that part of the assessment to see if you qualify for surgery has to do with finding out if your breasts are so heavy that they are causing other problems, with the curvature of the spine thing being one of the most common troubles. I myself wear a DD, and since they are both natural and of the fibrous type (firbrous breast tissue is both more dense and more heavy than regular breast tissue) by bust is quite heavy. However, I have had several doctors check, not at my behest, but just as part of a physical exam, and they have all determined that due to the size of my frame and skeleton (I have a very large frame for a woman of my height), as well as the muscles in my back, neck and shoulders, there is no undue stress from being that busty. That means that I would not qualify for a reduction which was covered by insurance. The two women I mentioned earlier both had much smaller frames and less developed muscles, which was part of the problem. My guess would be that they take it on a case by case basis and that there is no general rule or size which makes you eligible for a reduction covered by insurance. I think they just have to check and see if it is causing other problems. I would imagine that if you are on the small side as far as your frame, and if you have breasts which are larger than a DD, then you would probably have a better chance of being covered for the surgery.
I don't know about other options for financial help. I do know that here where I live surgeons are very good about allowing people to set up payment plans which require only a modest payment each month until the balance is paid in full. I have also been told that most of them, if you have to make payments, will not charge you interest if you keep your payments up and pay on time each month. If they do charge interest, it is a very tiny amount.
Another thing to consider is that where I live, most doctors do at least several surgeries each year for no charge at all. That may just be a regional custom, but it may be something they do in your area, as well. The doctors who do it here do them for people where the quality of life is an issue, and where the people absolutely cannot pay for what they need done. You might find out if there are any doctors in your area who do surgeries like that to help people out. While it isn't in the same area, I know someone whose dentist did implants, which cost about $6000, for free one year as one of his free cases. The same dentist also referred someone else to another dentist who was looking for a "free of charge" project he could do. Doctors may do the same types of things where you live--your challenge would be to find out who does them and if you qualify.
In all of this, there is just one more thing that I do know for certain. If you want a breast reduction for purely aesthetic reasons, you won't be covered by insurance, and you probably won't get any help from anywhere. Cosmetic procedures which are done solely for looks are generally considered to be entirely the responsibility of the patient.
I hope you can find the answers to all of your questions. I am sorry I don't have more good information for you.
Best of luck ;)
2007-12-20 09:51:55 · answer #1 · answered by Bronwen 7 · 1⤊ 0⤋
In some cases they will pay for a breast reduction, depending on the size. Alot of large breasted women end up with bad backs because of the weight problem and then theres the problem with the bra straps digging into their shoulders. If this is your problem then what you need to do is do a pre-approval, all your doctor has to do is send in the paper work ahead of time and they will tell him if they will pay for the surgery, he has to explain why you need it, and all the problems you are experiencing because of your breasts, so it is a case of talking to your doctor and finding out what he knows also he would know if there are any state agencies that will do the surgery for free, so GO ASK HIM. Good Luck
2007-12-20 10:59:24 · answer #2 · answered by kissingrizz 3 · 0⤊ 0⤋
Insurance will pay if you can prove that the reduction is a medical necessity that is needed to improve your health and quality of living. In cases where your breasts are so large as to cause back and shoulder pain, difficulty breathing, difficulty in certain movements, stretch marks across the shoulders, etc, insurance will often pay for the reduction if the procedure is presented properly by the Doctor in the paperwork. That is, the procedure is needed to improve your health and quality of living.
Other than a medical necessity such as this, the reduction is considered cosmetic and will not be covered by insurance.
2007-12-20 09:25:35 · answer #3 · answered by Chris A 1 · 4⤊ 0⤋
Yes, they do. Mine did 100%.
You don't necessarily need to be a certain size, its just the insurance company MAY have requirements for the MINIMUM amount that needs to be taken out to get covered and approval.
You can get financial help if they don't approve it, but I'd appeal like crazy until you are tired of appealing.
I had it Feb 2006 and don't regret it. Good luck in your journey!
2007-12-21 03:40:27 · answer #4 · answered by Terri 7 · 0⤊ 0⤋
if the reduction is medically warranted, the state insurance will usually pay for it. you need to talk to your cosmetic surgeon to determine if your size fits their requirements.
usually frequent infections under the breast folds, grooves in the shoulders, back pain, and the assumption of at least 500 grams of breast tissue will get you a reduction.
2007-12-20 09:21:37 · answer #5 · answered by Whims 1 · 4⤊ 0⤋
They will pay for a breast reduction if it is absolutely causing back problems. Mine paid for mine. As for the tummy tuck, absolutely not.
2016-04-10 10:10:31 · answer #6 · answered by Anonymous · 0⤊ 0⤋
no, insurance won't pay for that
2007-12-20 09:20:57 · answer #7 · answered by Anonymous · 0⤊ 3⤋