Insurance for Breast Reduction

It should be black and white. Cosmetic procedures are not covered by insurance, while medically necessary and/or reconstructive procedures always qualify for coverage. However, for semi elective procedures such as breast reduction surgery, also known as a reduction mammaplasty, the lines may blur. Before we continue discussing insurance coverage for breast reduction, it is important to understand that naturally large breasts can cause a significant number of side effects including:

• Neck pain
• Shoulder pain
• Back pain
• Rashes and
• Pain in the breast or chest

Due to the weight of the breasts, several musculoskeletal issues can develop over time. Patients will often speak to their gynecologist or primary care physician who will then likely refer the patient to a plastic surgeon such as Dr Szymanski.

The Nuances of  Insurance Coverage

Unfortunately, every plan varies in the coverage it provides. Insurance companies typically have a multitude of coverage requirements for surgeries such as breast reduction prior to preauthorization. These prerequisites may include:

• Multiple consultations with specialists including PCPs chiropractors, orthopedic surgeons, or dermatologists
• Physical therapy
• A history of musculoskeletal complaints likely due to large breasts

Since breast reduction walks a fine line between cosmetic procedure and necessary reconstructive surgery, insurance companies have made it harder to have these procedures covered. As such, it is important to contact your insurance company to understand more about the details of your policy. You should also contact us to discuss possible requirements and increase the chance that your procedure will be covered.

If you have changed or are planning to change insurance in 2022, be sure to speak to your insurance carrier, with plan details in hand, to discuss if these changes may alter whether you qualify for a breast reduction.

In the meantime, we understand how painful large breasts can be and we will work with you to compile the appropriate referrals and examinations required by your insurance company for coverage. We encourage you to do your homework and contact our office to learn more about how Dr. Szymanski can help and to schedule a consultation.