American Society of Plastic Surgeons
For Medical Professionals
 
Shellyne Gilchrist
one year ago
Answered

Swelling breast

Hay i have anthem blue cross thru Medi-Cal i been having breast pains lately and swolling and there making my back hurt and the just to heavy for me is there a way my insurance will cover a breast reduction precedure?

Procedure: Breast Reduction
Type: Question

Replies 3

Aaron Stone
ASPS Surgeon

I don't know about blue cross through medical but medical does not cover breast reduction for anyone. You have to get commercial health insurance and meet the coverage criteria of the specific plan in order to have the surgery covered.

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Debra Johnson
ASPS Surgeon
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If your breasts are a DD cup or larger, you would likely qualify for breast reduction surgery. Since you are in a MediCal HMO program through Blue Cross, you will need to see your primary care doctor and ask for a referral to a plastic surgeon. If the plastic surgeon you see thinks you are a good candidate for surgery, then he or she will need to send a letter to Blue Cross requesting authorization for the procedure. Once that is obtained you can get a date for surgery. All of this takes a bit of time, so in the meantime get yourself as healthy as possible: eat right, exercise, and keep your breasts as clean and rash-free as possible. Good luck!

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Nelson Castillo

Thank you for sharing your excellent question. Each insurance plan is a bit different in the procedures they will cover and I would reach out to Anthem directly to see the case of a breast reduction. Most likely if you can show that other attempts to improve your symptoms - weight loss, physical therapy, etc - have failed then you may be a surgical candidate. Hope this helps.

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