Feb 06 2009

Is breast reduction surgery covered by insurance?

Insurance companies vary greatly in their policies and practices about providing insurance coverage for breast reduction surgery.  Insurance companies generally examine the facts and circumstances of each case in an effort to distinguish a breast reduction procedure performed for cosmetic reasons from a breast reduction procedure which is done because of associated medical conditions caused by the breast size.

All insurance companies require that the breast tissue excised be weighed and all companies have a minimum requirement for the amount removed in order to qualify for coverage. Some companies also analyze the amount of tissue removed in comparison with the patient's height and weight.  This is one of the reasons that Plastic Surgeons often advise their patients to lose any excess weight before surgery.

To substantiate the medical necessity for the procedure, insurance companies look for a prior history of musculoskeletal imbalance with neck, shoulder or low back pain.  Many companies require documentation of visits to an orthopedist or chiropractor with a year of conservative therapy.  A prospective patient should check with her insurance company to find out if breast reduction surgery is a covered benefit on her plan and about the specific criteria used by her insurance company for coverage for breast reduction surgery.

To: Roger J. Oldham, M.D

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Roger J. Oldham, M.D

Phone: (301) 530-6100
Fax: (301) 530-6104