Does Health Insurance Cover Breast Reduction Surgery?

Large breasts. Some women long to have them, some women love theirs, and others want to get rid of them. They are great food shelves, but they come with some major downsides. This includes the inability to wear cute strapless shirts, or anything too low-cut. And button-downs or backless clothing? Forget it! Boob sweat sucks during the warmer months. But the worst part of having large breasts is the pain that accompanies them. Having large breasts can cause pain in your shoulders, back, and neck, can cause you to slouch, and can even leave indents on your shoulders from bra straps constantly digging into your skin. illustration of woman with pain from her bra

If you are like the thousands of women who experience these issues, then you might have thought about breast reduction surgery at some point in your life. But plastic surgery costs thousands of dollars, and may seem out of reach to most people. There is hope, though: in some cases, your health insurance will cover breast reduction surgery. 

Cosmetic Vs Reconstructive

Breast reduction, also known as reduction mammaplasty, can be considered both a cosmetic and a reconstructive  surgery. Cosmetic surgery is generally not covered by health insurance. But if you can prove that your “cosmetic” issue is causing a number of health issues, and that you have tried to treat these issues in other ways and failed, then it may be covered as a reconstructive surgery. 

Insurance Will Cover The Procedure If:back of a omwan with hair in a bun and her hand running her red shoulder

  • You have large breasts that can be reduced by 3 cup sizes or more
  • Your rashes or shoulder strap indents cannot be treated properly without a reduction
  • Documented weight loss did not reduce the size of your breasts
  • Your head, neck, shoulder or back pain is not gone after regularly visiting a physical therapist
  • You cannot exercise and maintain a healthy body weight because of the size of your breasts.

You have to prove that you have tried every possible treatment over the course of 6-12 months to relieve your pain and resolve any other issues stemming from having large breasts. Only once you get documentation of all of these health issues and attempted treatments will your insurance company consider covering your breast reduction surgery.

Even if you are approved you will probably have to pay a portion of the surgery( the amount depends on how much your insurance company covers), as well as your deductible and any coinsurance related to the surgery.

If You Are Considering Breast Reduction Surgery

paper that says medical record
Make sure you keep documentation of your medical records of all treatments you have tried.
  • Talk to your primary care physician about your symptoms to make sure that they are documented.
  • Call your health insurance company and see if they cover the surgery partially or in full.
  • Ask what documentation you need in order to be approved.
  • Make sure you do not need a second or third opinion from another doctor. Some companies will require 2-3 documented receipts from other referred specialists before covering your surgery.
  • If they will cover this surgery, ask your insurance company which surgeons are in their network .
  • If you are denied coverage, try appealing the decision.

Having breast reduction surgery can drastically improve your quality of life, so it is definitely worth looking into, especially since some insurance companies will cover it. You could be looking forward to a more active life with less pain and discomfort. You could also be looking forward to the added bonus of a free breast lift! Goodbye sag, and hello smaller and perkier breasts!

If you are looking for a company that will provide coverage for breast reduction surgery, then come to EZ and let one of our agents do all of the researching and comparing for you. EZ understands your struggles, and wants to make getting health insurance one less headache (or backache!) for you. Our agent will compare all the quotes in your area for free, and help you choose the best plan for you. No hassle or obligation. To get started, enter your zip code in the bar above, or to speak to one of our licensed agents, call 888-350-1890.

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