How To Get A Breast Reduction Covered By Insurance

Health insurance is great for doctor’s appointments, prescription medications, surgeries, etc. However, it doesn’t cover some things, including cosmetic surgeries. Some insurance companies consider breast reduction a cosmetic procedure unless you meet specific criteria. So, what makes breast reduction medically necessary, and what can you do to make sure your insurance will cover your breast reduction surgery?

What Makes Breast Reduction Medically Necessary?

Despite what some people may think, more prominent breasts aren’t always great. A lot of women with large breasts have problems with chronic pain in their shoulders, neck, back, or all of the above. They might have issues with bra straps digging into their skin and leaving painful marks. Some women also have chafing, rashes, or infections due to excess breast tissue and sweating.

Here’s a list of problems that make breast reduction medically necessary:

• Pain in the neck, back, or shoulders from carrying excess breast tissue
• Issues with mobility, including exercise
• Difficulty breathing, mainly when lying on your back
• Recurring skin irritation/rash or infection around or under the breasts
• Posture issues that are affecting daily life

There may be other symptoms that will qualify you for a medically necessary breast reduction. Basically, anything that is impacting daily life and stems from having large breasts will qualify as a symptom.

What Affects The Cost Of Breast Reduction?

It can be stressful to worry about meeting your insurance requirements for breast reduction surgery. It’s one of those things that makes you want to pay for the surgery and not even involve your insurance. If you’re thinking along these lines, you need to know what you might have to pay if you choose an out-of-pocket option. Here are some factors that affect the overall cost of breast reduction:

• Geographic location
• Surgical facility
• Surgeon’s fees 
• Pre-op and follow-up appointments
• Anesthesia costs

All these things can be pricey if you plan to pay out-of-pocket. The average cost of breast reduction in the US is around $9,000. 

Steps To Get Your Breast Reduction Covered By Insurance

The cost of breast reduction in the United States isn’t cheap, but there are financing options available through most plastic surgery practices that can help offset the price. But it would be nice if your insurance covered the whole procedure, and you wouldn’t have to pay anything.

So, what can you do to ensure your insurance will cover your breast reduction surgery?

• Know Your Insurance Requirements

Every insurance provider has different requirements you’ll need to meet before you can schedule your surgery. Most will require you to have specific documentation, have undergone additional treatments to improve your symptoms, or have a doctor (other than a plastic surgeon) recommend the procedure.

• Schedule An Appointment With Your Doctor

Once you know what you need to do to get insurance to provide coverage for your breast reduction, you can schedule time with your doctor. At this appointment, your doctor can evaluate you and record all of the symptoms and daily struggles caused by your excess breast tissue. They can then refer you to alternative treatments that your insurance may require you to try before you can undergo breast reduction.

• Try Alternative Treatments

Alternate treatment options usually include chiropractic adjustments, physical therapy, or specialists who treat pain, mobility, skin, or posture issues. After six to twelve months of treatment (or however long your insurance specifies) without significant improvement, you should be able to contact your insurance company about paying for your medically necessary breast reduction.

The Next Step Toward Your Medically Necessary Breast Reduction

After your insurance company recognizes your medical need for breast reduction, the next step is to find a plastic surgeon. At Allure Esthetic, you’ll get the best care from Dr. Sajan and his team. Call or text us at (206) 209-0988 to schedule your consultation today.