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Breast reduction surgery is considered a cosmetic procedure, and as such, is typically not covered by most medical insurance plans. However, in some cases, insurance may cover the cost of the procedure if it is deemed medically necessary.
Insurance may cover breast reduction surgery if the following conditions are met:
The procedure is performed to relieve physical discomfort and pain caused by large, heavy breasts. This may be documented by a primary care physician, specialist, or physical therapist.
The patient's BMI is within the normal range, indicating that the large breasts are not due to obesity.
The patient provides documentation of physical symptoms, such as neck and back pain, shoulder indentations, and skin irritation caused by large breasts.
The insurance company has approved coverage for the procedure in advance, known as pre-authorization.
The patient uses an in-network provider for the procedure, which is covered by the insurance policy.
How we can help
Provider Network
Our platform maintains a network of in-network providers who have experience in performing breast reduction surgery and are familiar with the insurance coverage requirements.
Cost Estimation
Our platform can provide patients with an estimated cost of the procedure, including any out-of-pocket expenses not covered by insurance, so that they can budget for their procedure.
Documentation Assistance
Our platform can assist patients in compiling and submitting the necessary documentation required for insurance coverage, including medical records and physical therapy reports.
Patient Advocacy
Our platform offers patient advocacy services to help patients navigate the insurance coverage process, including pre-authorization and appeals, if necessary.
Financing Options
ALPHAEON
With the ALPHAEON CREDIT card, you can access a variety of monthly payment plans to make your breast reduction surgery more affordable. Apply today and take the first step towards achieving your desired look and improved well-being.
CareCredit
The CareCredit credit card provides a convenient way to finance your breast reduction surgery, covering deductibles, copays, coinsurance, and expenses not covered by insurance. With promotional financing options, you can pay for your procedure over time. Apply today.
Insurance FAQ's
Breast reduction surgery is sometimes covered by insurance if it is performed for medical reasons, such as to relieve physical discomfort and pain caused by large, heavy breasts. The specific insurance coverage for the procedure will depend on the individual's policy and the circumstances of the case.
To determine if your insurance covers breast reduction surgery, you will need to review your policy or contact your insurance provider. They will be able to provide you with specific information about your coverage and any costs you may be responsible for.
To prove medical necessity for breast reduction surgery, you may need to provide documentation from your primary care physician or a specialist, such as an orthopedic doctor or physical therapist, confirming that your large, heavy breasts are causing physical discomfort and pain. You may also need to provide photos and measurements of your breasts.
The amount of the cost of breast reduction surgery that your insurance will cover will depend on your specific policy and the circumstances of your case. Some insurance providers will cover the entire cost of the procedure, while others may only cover a portion of the cost.
Whether you will need to pay a deductible or copay for breast reduction surgery will depend on your specific insurance policy. Some insurance policies require a deductible or copay for certain types of procedures, while others do not.
If your insurance company denies coverage for your breast reduction surgery, you may be able to appeal the decision. This will involve submitting additional documentation or information to support your case, and in some cases, a hearing may be scheduled.
The insurance approval process for breast reduction surgery can take several weeks or more, depending on the specific insurance company and the circumstances of the case. It is important to start the process as soon as possible to ensure that you have the coverage you need in a timely manner.
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You already have an insurance?
Let us arrange a counsultation with one of our best surgeons in this field as a first step, During this visit, the surgeon will evaluate your case.