Will Insurance Cover The Cost of My Breast Reduction Surgery?

Yes, it is possible that your insurance may cover the cost of breast reduction surgery, but you will have a difficult time trying to convince the insurer that it is for reconstructive purposes, and not cosmetic. Breast reduction surgery insurance is often considered an unnecessary expense because it is assumed to be an elective plastic surgery whose cost should be covered by the patient, unless sufficient evidence is presented to prove otherwise.

The burden of proof is on you, the patient.

While most insurance companies avoid being too involved in the patient’s medical condition, this is not the norm when it comes to breast reduction surgery. The patient is often expected to go to great lengths to prove that they need breast reduction surgery for medical reasons.

The weight of large breasts often affects the musculoskeletal system, which results in excruciating pain in the neck, shoulder, and back. Other symptoms that the weight of the breasts is overwhelming the body include breast pain and rashes beneath the breasts.

Unfortunately, these symptoms and the recommendation of a doctor is sometimes not enough to convince an insurance company reviewer that the reason for the surgery is not cosmetic. Of course, the outcome will also be cosmetic, but the primary concern should be the patient’s health.

Some companies assume that patients asking for cover for breast surgery are using the medical aspect as a cover to get an aesthetic treatment. This is why many health insurers refer the patients to two or three doctors who are expected to verify if indeed the surgery is necessary or not.

Companies look at surgery as a last resort.

Before they accept to cover breast reduction surgery, some companies ask if you have tried alternative treatments before opting for a permanent solution. This is certainly not because they are concerned about the risks of breast surgery, but are looking at cheaper alternatives.

This is why some go as far as asking for documentation showing at least 6-12 months of treatment with a physical therapist, dermatologist, orthopedist, or chiropractor. So, even if you are suffering medically, you will have to go through months of pain to convince the insurer that the reconstruction is necessary for your well-being.

Policies vary from one company to the next.

Due to the sensitive nature of breast reduction surgery, insurance companies do not have standard policies. Some insurers go as far as changing the coverage criteria annually, so what was acceptable last year may not be this year. So, if you need breast reduction surgery, ensure you ask for the coverage under your insurance policy.

Some health providers have less stringent policies, so if your neighbor has an easy time getting approved for the surgery, you may not be as lucky. It is best to find out about the possibility of breast reduction surgery cover early so that you can find out if your insurer will cover it and the process you’ll need to go through before your request is approved.

The cost of breast reduction surgery determines if your insurer will cover the procedure or turn down your request. If you can get favorable rates, the insurance company might be willing to cover the cost of breast reduction surgery.