How Do You Get Health Insurance to Cover your Breast Reduction Procedure

Breast Reduction surgery can occasionally be covered by your health insurance.  However, most health insurances require permission or pre-certification, to ensure payment.  Health insurance companies across the country have different requirements, but some are fairly general and are widespread. To obtain pre-certification, your plastic surgeon will meet with you and discuss with you what needs to be done before surgery can be scheduled. 

Having large breasts ormacromastia, is the most obvious reason for wanting a breast reduction.  Typically, you may be experiencing neck, back, and shoulder pain.  You may have grooving of the soft tissue and skin of your shoulders because of your bra strap creating a skin fold in your upper shoulders.

Intertrigo, also known skin irritation, may occur in your breast fold, because your breast tissue is so heavy and may generate pressure on your breast fold area.  Documented cases of breast intertrigo may require skin creams or antibiotics to help prevent it.

Your weight should be proportionate to your height. Your health insurance company will probably not approve surgery for breast reduction if you are significantly overweight. Larger or overweight women may have larger breasts, and overall weight loss may result in smaller breasts. 

Physical therapy may help with neck, back, and shoulder pain.  If your family doctor has recommended physical therapy first, then this may help with your pain.  If you still have continued pain from bilateral macromastia after trying physical therapy, then you have a slightly stronger case to get your beast reduction surgery authorized.

Photographic documentation is key to get approval for breast reduction surgery.  Your plastic surgeon will probably take photographs of your chest and then your health insurance company authorization panel will want to review them to ensure that you are a candidate for surgery.

Every health insurance company will vary a little in terms of what requirements they need regarding breast reduction surgery. You may have to take a more active role than you realize to get your surgery approved.  Although your Plastic Surgeon will handle the initial request and submission of forms, you may have to contact your health insurance company to speed the process along.

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