FAQ Insurance Questions: Breast Reduction

Will My Breast Reduction be covered by insurance? 

Insurance coverage for a breast reduction procedure depends on a variety of factors and will be discussed in detail at your consultation. If insurance coverage is possible, a pre-determination will be sent to your insurance plans prior to scheduling. This will ensure there is an approval on file for medical coverage prior to surgery. If an approval is received you may still be subject to your deductible, out of pocket payment, and co-insurance under your plan’s terms and conditions.

what if my insurance denies my request?

If a denial is received our office can file an appeal. If that appeal is then overturned into an approval you will be contacted and scheduled. If the denial is upheld you can work with our cosmetic coordinator to proceed with scheduling.

What needs to be submitted for a pre-determination? 

Most insurance providers require clinical notes from physicians as well as photographs. Other documentation that may be helpful are notes from physical therapists, chiropractors, and proof of other methods that were used to try and alleviate discomfort prior to surgery.

Why may insurance companies not pay for Breast reduction? 

Breast reductions can be considered a cosmetic procedure unless an adequate amount of health issues and attempted remediation of those issues has occurred prior to surgery. Every insurance company will have different criteria that needs to be met prior to approving breast reduction surgery.

Where can i find criteria to qualify for breast reduction surgery?

It will be helpful to call member services located on the back of your insurance card. By doing so, you will speak to a representative who can offer information about your specific plan. Many insurance plans also have online medical policies that can be found on the plan’s homepage.