Does Insurance Cover Breast Reduction Surgery?

May 16, 2015 — by Stephen Hardy M.D.
Tags: Breast Reduction Plastic Surgery

Woman with a large bust lineA breast reduction procedure to minimize the size and weight of the breasts is typically classified as a cosmetic surgery. However, more often than not, we find that patients who come to Dr. Stephen Hardy inquiring about this procedure are interested in changing much more than their appearance. A breast reduction can reduce the weight of overly heavy and dense breasts. If a patient’s breasts are too large for the overall size and shape of her body, it can result in physical limitations, physical pain, and emotional discomfort. In these cases, patients may qualify for medical insurance coverage for their breast reduction procedure. Our staff can discuss breast reduction surgery and insurance coverage with our Missoula patients, and determine if they are eligible for any financial coverage.

Insurance Coverage

Typically, any surgery that is a cosmetic procedure is considered to be purely elective and is not eligible for any insurance coverage. However, there are insurance providers that will offer at least partial coverage for a cosmetic procedure if it is being performed for medical reasons. Because breast reduction surgery can relieve physical pain and strain, it is one cosmetic procedure that is sometimes covered by insurance providers. Because each insurance company and policy is unique, it is important for patients to carefully examine their insurance policy and speak with an insurance representative to determine if they may qualify for coverage toward a breast reduction procedure and, if so, how much coverage is available.

Working with Insurance Providers

If insurance coverage is available, the insurance provider may be particular about the type of documentation that is needed to qualify for coverage. Our staff and Dr. Hardy are happy to work alongside our patients to ensure that all necessary information is provided. Below are some of the types of documentation that may be requested by an insurance provider in cases of breast reduction surgery:

  • Letter of symptoms experienced by the patient as a result of breast size
  • Receipts from any medical treatments previously provided to the patient (such as prescriptions or chiropractic appointments)
  • Physical findings in regards to the current state of the body, including photos and reports from your primary care physician and plastic surgeon
  • An estimation of how much weight would be removed from the breasts during surgery; in many cases, a certain amount of weight must be removed from this breasts

In most cases, this information is required before surgery so that prior authorization can be provided before scheduling the breast reduction procedure. Dr. Hardy and his staff have worked with insurance providers and are willing to work within their timeframe to provide necessary documentation prior to surgery.

Schedule an Appointment

A breast reduction procedure can greatly reduce the physical pain associated with overly large breasts and help women regain a sense of comfort and physical freedom. If you are interested in learning more about breast reduction surgery and would like to know if you are an ideal candidate, schedule an appointment with Dr. Stephen Hardy at your earliest convenience. We look forward to hearing from you!

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