Women that have breasts that are too large for their frame; cause back, neck, and shoulder pain; and interfere with exercising or other physical activities are usually excellent candidates for breast reduction surgery.
However, many patients with excess breast tissue are unsure if their insurance will cover the cost of the procedure and want to know: Do I qualify for a breast reduction?
Continue reading to learn the standard criteria for a medically necessary breast reduction and what the approval process entails.
Do I Qualify for a Breast Reduction?
If you have heavy or large breasts that are not proportionate to your body, you may be wondering: Do I qualify for a breast reduction?
The decision to undergo breast reduction for purely cosmetic purposes is up to the patient and surgeon and usually paid out-of-pocket.
On the other hand, qualifying for a medically necessary breast reduction, with associated coverage, is decided by the woman’s insurance company. In most cases, insurance will pay for all or some of breast reduction cost if the patient can prove that the procedure will alleviate health issues that are causing pain and impairment.
What is the Approval Process for Breast Reduction?
In addition to asking – Do I qualify for a breast reduction? – patients are often curious exactly how they can get approved for insurance coverage.
To start, you will need to undergo a thorough exam by a board-certified plastic surgeon who will evaluate the size of your breasts, amount of removable tissue, and signs of medical issues such as bra strap indentations in the skin.
Your surgeon will also take a number of photographs of your body from the neck down, which are then submitted to an insurance company panel for review. The panel typically assesses:
- Patient height and weight
- Amount of removable breast tissue
- Proof that breast size and weight are causing observable health issues
The standard criteria for a medically necessary breast reduction is usually 400 to 2000 grams (1-4 pounds) of removable breast tissue and often met by patients with DD, DDD, and H cups.
Want to Learn More About Breast Reduction Qualifications?
If you are considering surgery and wondering – Do I qualify for a breast reduction? – please call our office today to schedule a comprehensive consultation with board-certified plastic surgeon Dr. Navin Singh.
