What to Know About How Insurance Coves Breast Reductions

Yes, insurance will cover breast reduction in most cases. The procedure is considered medically necessary for patients who experience back pain or other problems due to large breasts. Most insurance plans will require that you try conservative treatments like weight loss and exercise first, but if those don’t work, breast reduction surgery may be covered.

Many women suffer from back and neck pain due to the size of their breasts. Breast reduction surgery can help alleviate this pain by reducing the size of the breasts. However, some women worry that their insurance will not cover this type of surgery.

Most insurance companies will cover breast reduction surgery if it is medically necessary. This means that your doctor must determine that your large breasts are causing you physical pain or other health problems. If your doctor provides documentation of this, your insurance company should approve coverage for the surgery.

However, even if your insurance company covers breast reduction surgery, you may still be responsible for some out-of-pocket costs. These could include things like co-pays, deductibles, and any fees associated with the use of an in-network surgeon or facility. Additionally, not all types of breast reduction surgery may be covered by insurance.

For example, if you elect to have cosmetic breast reduction surgery (i.e., surgery solely for aesthetic purposes), it is unlikely that your insurance company will provide coverage. If you are considering breast reduction surgery, be sure to speak with your doctor and check with your insurance company to find out what costs may be covered by your plan.

Will insurance cover breast reduction surgery?

What Size Breasts Qualify for Reduction?

There is no definitive answer to this question as it depends on a number of factors, including the individual’s body type, their desired results and the advice of their surgeon. However, generally speaking, breasts that are significantly larger than average or that cause pain or other medical problems may be candidates for reduction surgery. It is important to consult with a board-certified plastic surgeon to discuss whether breast reduction is right for you.

Will Insurance Cover Breast Reduction If You are Overweight?

Most insurance companies will not cover breast reduction surgery if you are overweight. The reason for this is that they consider the surgery to be cosmetic in nature and not medically necessary. There are a few exceptions, however.

If you have very large breasts that are causing back or neck pain, your insurance company may be more likely to approve the surgery. In addition, if you can show that your large breasts are impacting your quality of life in a negative way, you may also be able to get coverage. Ultimately, it is up to each individual insurance company to decide whether or not they will cover the cost of breast reduction surgery for overweight patients.

How Much Breast Tissue Needs to Be Removed for Insurance to Cover?

There is no definitive answer to this question as it depends on a number of factors, including the insurance company’s policy and the individual’s medical situation. However, in general, most insurance companies will only cover breast tissue removal if it is deemed medically necessary. This means that the patient must have a condition that warrants the removal of breast tissue, such as cancer or a severe infection.

The amount of breast tissue that needs to be removed will also depend on the extent of the condition. For instance, if a patient has early-stage breast cancer, they may only need to have a small amount of tissue removed. However, if the cancer is more advanced, they may need to have a larger section of their breast removed.

Is Breast Reduction Surgery Painful?

The short answer is yes, breast reduction surgery is painful. However, the degree of pain and discomfort experienced varies from person to person. Additionally, there are a number of things that can be done to help manage pain both during and after the procedure.

During breast reduction surgery, pain is caused by the incisions being made in the skin as well as by the manipulation of tissue. To help manage this, your surgeon will provide you with a general anaesthetic which will make you feel sleepy and pain-free throughout the procedure. You may also be given a local anaesthetic to numb the area around the incisions.

After breast reduction surgery, you will likely experience some pain and discomfort for a few days or weeks. Again, this will vary from person to person. Your surgeon will prescribe you medication to help control any pain and may also recommend using ice packs and/or wearing a supportive bra to help reduce swelling.

Most people find that their discomfort improves gradually over time and is manageable with over-the-counter medication within a few weeks.

Will Insurance Cover Breast Reduction

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How to Get Insurance to Pay for Breast Reduction Blue Cross Blue Shield

In order to get insurance to pay for breast reduction, you will need to have a consultation with a board certified plastic surgeon. During this consultation, the surgeon will evaluate your breasts and determine if you are a good candidate for the surgery. If the surgeon believes that you are a good candidate, they will submit a pre-authorization request to Blue Cross Blue Shield.

Blue Cross Blue Shield will then review the request and make a decision based on their Medical Policy guidelines. In order for them to approve the surgery, they typically require that patients have tried other methods of treatment first, such as physical therapy, weight loss, and changes in posture. Additionally, patients must have documentation from their primary care physician or gynecologist stating that the large breasts are causing health problems.

If you meet all of these requirements and your surgery is approved, Blue Cross Blue Shield will cover breast reduction surgery. However, it is important to note that there may be some out-of-pocket costs depending on your individual policy coverage.

How to Get a Breast Reduction Covered by Insurance

If you are considering a breast reduction, you may be wondering if your insurance will cover the cost. Here is some information about how to get a breast reduction covered by insurance. Most insurance companies consider breast reduction to be a cosmetic procedure and will not cover the cost.

However, there are some exceptions. If you have large breasts that cause pain or other medical problems, your insurance company may be more likely to cover the cost of surgery. To increase your chances of getting coverage, it is important to document your symptoms and their impact on your life.

Your doctor can help you with this by writing a letter describing your condition and recommending surgery as the best treatment option. You should also keep track of any medication you take for pain relief or other medical problems related to your breasts. Once you have gathered all of this documentation, you can contact your insurance company and request pre-authorization for surgery.

This process can be time-consuming, so it is important to be patient and persistent.

Price of Breast Reduction With Insurance

The price of breast reduction with insurance can vary depending on your specific policy. However, there are a few things that you can expect to pay for when it comes to this procedure. First, you will likely have to pay a deductible.

This is the amount of money that you must pay out-of-pocket before your insurance company starts paying for the rest of the procedure. Second, you will probably have to pay coinsurance. This is the percentage of the bill that you are responsible for after the deducible has been met.

For example, if your procedure costs $10,000 and your insurance plan has a 80/20 coinsurance, then you would be responsible for $2,000 (20% of $10,000). Lastly, some insurance plans also require that you pay a copayment for each office visit or prescription related to your breast reduction surgery. A copayment is a set dollar amount that you must pay at the time of service (for example, $25 per office visit).

So how much does breast reduction surgery cost with insurance? It really depends on your individual policy terms and conditions. However, we can give you some ballpark estimates based on common insurance coverage levels.

If you have a high deductible health plan (HDHP), then you can expect to pay anywhere from $3,000-$5,000 out-of-pocket for breast reduction surgery. If you have a standard health plan with moderate deductibles and coinsurance rates (80/20 or 70/30), then your total cost could be closer to $5,500-$7,500. And finally, if you have comprehensive coverage with low deductibles and coinsurance rates (60/40 or 50/50), then your total cost could be around $8,000-$10,000+.

These are just estimates though – ultimately it all depends on what type of coverage YOU have!


If you are considering breast reduction surgery, you may be wondering if your insurance will cover the procedure. Breast reduction is usually considered a medically necessary procedure, which means that most insurance plans will provide some coverage for it. However, there are often limits on what is covered, and you may be responsible for paying some or all of the costs yourself.

It is important to check with your insurance company before having the surgery to find out exactly what they will and will not cover.

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