For many women, a breast reduction surgery in New Jersey relieves a host of unwanted symptoms, from neck and back pain, to uncomfortable skin rashes, unwanted glances, and general self-consciousness.
In this way, every plastic surgeon knows that breast reduction surgery can be a life-changing milestone. But what if you don’t have enough money to pay for this procedure out-of-pocket? Does breast reduction fall under your insurance coverage?
Does Insurance a Cover Breast Reduction?
Unfortunately, there are many misconceptions related to breast reduction and insurance. Many are confused wondering does insurance cover breast reduction surgery?
As a blanket statement, breast reductions are not necessarily going to be covered by your health insurance plan, so don’t plan on it falling under your insurance coverage, or you may be disappointed.
Still, there are situations in which some health insurance plans will cover breast reduction. Basically, it’s up to you to discuss your options with your provider and see what, if any, hoops you’ll have to jump through in order to get your procedure to fall under your insurance coverage.
For example, most major insurance companies want to know that you’ve had a history of symptoms and health concerns related to excessively large breasts. They want to know that you’ve tried various other tactics in order to eliminate this problem on your own, such as losing weight, working with a physical therapist or trying different undergarments.
They also want to know that the pains you are experiencing from this condition are real. So, they may ask to see evidence of prior medical appointments related to having excessively large breasts.
Again, however, this varies from insurance company to insurance company. Most insurance companies and/or plans won’t cover breast reduction at all. Others will cover them only if you follow a certain protocol.
When is Breast Reduction Considered a Medical Necessity?
Breast reduction surgery covered by insurance depends largely on whether the procedure is classified as a medical necessity, rather than a cosmetic procedure that is considered cosmetic by an insurance carrier.
Patients with overly large breasts often experience chronic pain, neck pain, shoulder pain, back and shoulder pain, breast pain, skin irritation, and other physical symptoms that interfere with daily life. In these cases, coverage for breast reduction may be possible when the medical condition is well documented.
To obtain insurance coverage, most insurance carrier reviews require proof from a primary care physician and other healthcare providers, showing failed conservative treatments such as physical therapy, weight management related to body mass index, and ongoing medical history of medical symptoms.
Detailed medical records are critical to demonstrate medical necessity (including that the procedure is not merely considered cosmetic). When appropriate, breast surgery, specifically reduction mammoplasty or reduction mammaplasty, may be approved as a surgical procedure if it aims to relieve symptoms caused by excessive breast volume.
A formal breast reduction consultation allows the surgeon to assess breast surgery goals, select the appropriate surgical technique, and submit documentation for insurance authorization and insurance approval under the patient’s insurance policy.
While coverage for breast reduction and overall breast reduction coverage vary by plan, patients who meet criteria for medical necessity may find their breast surgery is not treated as a purely cosmetic procedure, increasing the likelihood that breast reduction surgery covered benefits apply.
How Much Does Breast Reduction Cost?
According to the American Society of Plastic Surgeons, breast reduction surgery costs around $6,000 on average, but this doesn’t include many required fees. Therefore, the entire surgery may cost more like $8,000 or more.
To get a breast reduction covered with your plan, the price of breast reduction with insurance will also vary. That is, you may still have to pay for part of your surgery, but the overall cost may be reduced.
Ultimately, the cost of breast reduction surgery can be broken down into several fee categories:
- Fee for your plastic surgeon
- Anesthesiologist’s fee
- Cost of anesthesia
- Cost of surgical facility or hospital
- Out-of-pocket costs (medical tests and additional doctors appointments, for example)
- Post surgery garment and equipment expenses
- Medication fees
Breast Reduction Before and After: Healing, Recovery, and Scars
Viewing breast reduction before and after results helps patients understand realistic changes in shape, size, and overall comfort. These images often show improved proportions and posture once healing is complete, especially in a healed breast reduction outcome.
During recovery week by week, swelling and soreness gradually decrease as the body heals. Most patients notice steady improvement in comfort and mobility, with clearer results emerging over time. While surgery scars are a natural part of the procedure, they typically fade and soften with proper care, becoming less noticeable as healing progresses.
Questions and Answers: Does Insurance Cover Breast Reduction Surgery
What size breasts qualify for reduction?
This depends on a multitude of factors, including what types of symptoms you’ve been having that are related to the size of your breasts and how big your frame is in relation to your breasts.
Ultimately, your general practitioner or family doctor can tell you whether they think you may benefit from breast reduction surgery. Then, that medical professional can refer you to a plastic surgeon to discuss breast reduction surgery.
You can also book a breast reduction consultation appointment with a plastic surgeon on your own if you think you may qualify. Your plastic surgeon will give you a medical examination and help you decide whether breast reduction is a good idea for you.
Will insurance cover breast reduction if you are overweight?
Not always, but sometimes. Generally, your insurance company will want to know that you are within a healthy body weight range before they will cover breast reduction surgery. That’s because sometimes losing weight will reduce the size of a woman’s breasts, thus eliminating the issue without the need for surgery.
Furthermore, not all major insurance companies will cover this procedure in the first place. If they do, most want to know that you’ve attempted other ways of mitigating the negative effects of having large breasts.
How much weight is removed in breast reduction?
Your plastic surgeon will tell you that the majority of women with excessively large breasts will lose between two and eight pounds from breast reduction surgery. Many women go on to lose more weight because with smaller breasts, they have an easier time exercising, their confidence is boosted, and they’re excited about making more positive changes in their lives.
How much breast tissue needs to be removed for insurance to cover it?
If your health insurance company is going to cover your breast reduction, they’ll want to know that you need significant breast tissue removed in order to achieve your positive results. In other words, they want to know that surgery is really necessary for you and that if you were to undergo the surgery, a significant reduction in your breast size would be achieved so that you would benefit.
For this reason, an insurance company who might cover your procedure will want to talk to your plastic surgeon and know that you need at least 500 grams of tissue taken off from each of your breasts. This will vary, however, so speak with your provider.
Does Blue Cross cover breast reduction surgery?
For those who want to learn more about the possibility of having breast reduction covered by insurance Blue Cross is a common provider. Ultimately, you won’t know whether Blue Cross covers this procedure until you speak with them directly and look at your plan.
For many who want to know how to get insurance to cover breast reduction Blue Cross Blue Shield sometimes has a handy tool available. The Blue Cross Blue Shield breast reduction calculator or guide can walk you through the steps. Contact BCBS to learn more.
Does insurance cover breast reduction for back pain?
In some cases, insurance may cover breast reduction for back pain if it is considered a medical necessity. Most insurance providers require documentation showing chronic back pain, failed non-surgical treatments, and medical records from a physician confirming the condition. Coverage varies by plan, so it’s important to review your policy and speak directly with your insurance provider.
Book a Consultation Today with Dr. Smita Ramanadham
Dr. Smita Ramanadham performs breast reduction surgery for patients in New Jersey. If you have been thinking about the possibility of breast reduction surgery, schedule your consultation with Dr. Ramanadham.
There’s no reason to go on living an uncomfortable life with many symptoms related to excessively large breasts. Find the new you after breast reduction surgery.