As soon as a woman decides she is interested in a breast reduction, plastic surgery to reduce the size of breasts, one of the first things she does is research the cost of the surgery, also known as reduction mammoplasty. The initial reaction can be sticker shock, as some fees typically run upwards of $8,000, including the surgeon’s fee, surgical center fee, and anesthesiology fee.
As with all cosmetic procedures, in-house financing is often an option. Breast reduction surgery can be unique in that while it is a cosmetic surgery performed by a surgeon specializing in plastic surgery, in some cases it can be considered a medically necessary procedure covered by your insurance.
Typical Reasons for Coverage
Insurance companies will often use a checklist to determine if they will cover your breast reduction. They will consider a patient history of complaints of physical pain in neck or back, postural complaints, and “ridges” on the shoulders due to bra straps cutting in.
Some insurance companies will use a pre-set formula to determine if your breasts are large due to excess tissue or weight gain. It is helpful to try to lose some weight before you apply for insurance coverage. Of course, large breasts can make exercising painful, so you will not be expected to be at your “perfect weight” for coverage.
Most insurance companies will want an estimate of the amount of tissue your surgeon thinks he will be removing. This can be a particular gram amount, although some insurance companies will use a formula to make sure smaller statured patients require a smaller gram amount.
Patients requiring breast reduction to match the size of a breast previously treated for cancer are automatically covered. Your surgeon will often present the “before” pictures of your breasts to the insurance company as part of the assessment package.
Discuss Your Concerns at Your Consultation
You should discuss procedural costs and likelihood of coverage during your consultation. Your surgeon will work with your insurance company to get you covered, but sometimes in “close call” cases, the insurance company may request letters from your general practitioner to confirm that you are qualified for breast reduction plastic surgery. Remember, your surgeon has ample experience presenting authorization requests to insurance companies, and will be very familiar with the process and requirements.
