American Society of Plastic Surgeons
For Medical Professionals
lanija banks
4 months ago

Breast Reduction

I want to know that even though I don’t have 12 months documentation of pain and extreme discomfort in my medical records, could I still get my insurance to cover my breast reduction with the help of a doctor of some sort?

Procedure: Breast Reduction
Location: malvern, AR

Replies 2

Rahul Vemula
ASPS Surgeon
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I do a fair amount of insurance breast reductions. If you do not meet insurance criteria, and do not follow their guidelines to the letter, unfortunately, they will not cover it.

Each insurance plan has a different requirement. Call member services for your specific insurance plan and have them send you the guidelines for what the criteria is to get the reduction covered.

Alfred Antonetti
ASPS Surgeon

The doctor will help you get approved by the insurance company but they will not tell any lies just to get you approved. Each company is a little different but most would want to see that you have pain in the back, neck and shoulders, that you have used special support bras that are expensive and actually do not work but they ask for it anyway. They want to see that you have had rashes under the breast folds that continue to reoccur even after you taking measures such as keeping dry or using medicines, etc. They may want you to have gone for some kind of physical therapy that also does not work but you may be able to get around it by stating that you have been doing back strengthening exercises on your own 3-4 time a week. They may want to see that you have taken pain meds even such as Tylenol, Naprosyn or Motrin for some period of time and that it does not work. Then there is certain amount of weight that needs to be removed according to your height and weight. See your surgeon.


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