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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How to find health insurance that covers breast reduction
Ask a Surgeon - Breast Reduction
Reduction mammoplasty for asymptomatic members is considered cosmetic. Aetna considers breast reduction surgery medically necessary for non-cosmetic indications for women aged 18 or older or for whom growth is complete i. Note : Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. The condition not only must be unresponsive to dermatological treatments e.
For up-to-date information on procedure costs, see the Average Costs page. Archived questions on Surgery. I am 25 years old.
Since many of our patients come to Dr. Golshani with substantial physical complaints due to their breast size, most of these patients have been able to get insurance to cover their surgery costs. Golshani works with a experienced Insurance Specialist in Los Angeles who will help you understand the decision-making process, provide you with advice, and walk you through this step-by-step in order to maximize the chances of your insurance company paying for the surgery. Thus, they may refuse coverage for women seeking this procedure.