Each insurance company has its own set of criteria, but here are the most common qualifications that are required to be eligible for insurance coverage of breast reduction. Patients who suffer from chronic back, neck, and shoulder pain because of their overly large breasts are the most likely candidates to be eligible for coverage. Recurrent inflammatory conditions under the breasts can also be considered an acceptable qualification. These conditions must be monitored and documented by your primary care physician as well as any chiropractor or orthopedic surgeon who has cared for you. These medical professionals may need to submit letters to your insurance company along with evidence that a breast reduction will relieve your symptoms.
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Will insurance pay for my breast reduction surgery? In general, the answer depends on several factors. Who is having the surgery and what are their reasons? There is a specific process you can go through, which involves both a surgeon and your insurer. If your insurance lists reduction mammoplasty as an exclusion, this means your insurance will not cover the procedure. Most insurance companies will NOT have this listed as an exclusion.
I recently saw a female college student as a new patient consultation in my office concerning possible breast reduction surgery. This procedure, also known as reduction mammaplasty, is indicated for the treatment of symptomatic macromastia large breasts. The commonly reported symptoms related to macromastia are neck, shoulder and back pain caused by the weight of overly large breasts upon the musculoskeletal system. Other secondary symptoms can include breast pain and dermatitis or rashes beneath the breasts.