Will insurance likely cover my breast reduction?

Thank you for your question! Breast reduction is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine, which sounds like your situation. Recently, managed care has adopted stricter standards for coverage, so make sure these problems are thoroughly documented in writing by your primary care physician and plastic surgeon. They may also have to submit photographs. Even then, you may be required to seek a second opinion from a chiropractor, physical therapist, or orthopedic surgeon. Large breasts may not only interfere with your physical ability to function in daily activities but can be emotionally burdensome as well. Breast reduction surgery removes excess breast tissue and reshapes the contour of the breasts so that they are smaller and perkier. I suggest you make an appointment with a board-certified plastic surgeon who can go over your options in detail.

Helllo, I’m sorry to hear that you are suffering with this issue. The majority of insurance companies should cover your breast reduction typically if the following can be documented:
1. Failed non surgical treatment such chiropractic care or physical therapy
2. Failure of prescribed medications such as muscle relaxants and/or NSAIDS (non steroidal anti inflammatory drugs)
3. Changes in your activities of daily living (ADL) such as the inability to care for your self or family due to pain, inability to participate in physical activities and/or use of specialty bras
4. Neck pain, back pain, shoulder grooving and/or skin changes by physical examination
Seeking out a primary physician first for a general exam to exclude other potential problems that could cause neck and back pain is the first step followed by referral to a board certified plastic surgeon for final evaluation and treatment.
I hope you find this helpful. Best wishes.

Earl Stephenson, Jr, MD, DDS