How To Get A Breast Reduction Covered By Insurance

Extremely large, disproportionate breasts and breast tissue, also known as macromastia, is a serious issue for many women. Macromastia can interfere with many basic functions, such as sitting or standing properly, exercising, and sleeping. The excess tissue pulls on your back and shoulders, causing tenderness, pain, swelling, poor posture, and difficulty lifting.

Macromastia is a medical condition. Some forms of macromastia can be addressed through non-surgical treatments. However, some forms can only be remedied by reduction mammaplasty, or breast reduction. In many cases, breast reduction can relieve man y of the symptoms of macromastia, giving women the freedom to move and do as they please.

How to Get a Breast Reduction Covered by Insurance

If you are considering having a breast reduction procedure, you are probably aware of the financial burden of the procedure. You should begin by reading your insurance policy. Some insurance policies come with mammaplasty exclusions, which means that you might not have coverage for a mammaplasty consultation with a physician. If this isn’t the case, the next step will be to set up a consultation with an aesthetic-and-reconstructive surgeon.

Preauthorization

Most insurance providers will want you to get preauthorization for a breast reduction procedure. Depending on your insurance provider, this will involve getting a recommendation from your surgeon that you are a good candidate for reduction mammaplasty. Your surgeon will take photos of your breasts and breast tissue. These pictures will be sent to a board of doctors and surgeons who work for the insurance company. This board will review your medical history and current information in order to determine if breast reduction is medically necessary in your case. A variety of factors, such as your height, weight, breast size, and weight of the breast tissue will be used to determine if you will receive insurance for breast reduction.

In the Event of an Initial Rejection

If your insurance provider initially rejects your coverage, saying that the breast reduction is cosmetic, there is still a possibility that you could get coverage. You have a right to appeal the provider’s findings. Have your surgeon contact the insurance company and explain why you are a good candidate for the procedure. Letters of support from other medical professionals, therapists, and family members can also help. Up-to-date insurers will have the latest literature available on mammaplasty, but some insurance providers use older, outdated methods to determine if patients qualify for insurance for breast reduction.

Authorization

Once your authorization comes through from the insurance company, you can schedule the breast reduction with your surgeon. With most insurance coverage, you will only be responsible for the co-pay for the procedure. Co-pay for treatment in a hospital or similar facility ranges from $100 to $300. This is much cheaper than paying the full price of the breast reduction!