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Does Insurance Cover Breast Reduction?

Does Insurance Cover Breast Reduction

For many women, a New Jersey breast reduction surgery 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 surgeons 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 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.

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

Questions and Answers

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.

Book a Consultation Today

Does Insurance Cover Breast Reduction SurgeryDr. 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. Schedule your appointment today.


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