Insurance Coverage and Breast Reduction Surgery
Insurance companies generally regard breast reduction as a cosmetic surgery and therefore will not cover it. It certainly may give a cosmetic enhancement to your body proportions. But that does not mean it won’t also relieve pain and save you from
- Back problems
- Skin irritation
- Nerve damage, and
- Breathing problems,
to name just some of the problems caused by over-large breasts.
Even when a cosmetic surgeon can successfully show that significant health benefits will flow from a breast reduction, most insurance companies still apply limitations. If less than 500 grams of tissue are removed from each breast, they will not cover the surgery.
The mistake there is to look at the number of grams in isolation from other factors such as the woman’s frame size. For the same health benefits, a smaller woman will generally need less tissue removed than a larger woman. It’s a matter of each woman’s body proportions, not their absolute size. Many companies claim that smaller women want breast reduction for cosmetic reasons, and that relieves the companies from having to pay out anything (always a high priority for insurance companies).
In 2006 a study was done by the American Society of Plastic Surgeons (ASPS) called Reduction Mammoplasty: A Review of Managed Care Medical Policy Criteria. The researchers examined the criteria of 85 health insurance policies on breast reduction and compared them to the medical literature on breast reduction indications (that is, criteria that plastic surgeons use to justify doing the procedure).
They found no insurance company policies for breast reduction coverage that were supported by the medical literature. They concluded that insurance company criteria were “arbitrary and without relevance to the published studies on the indications for this procedure”.
If you are interested in having breast reduction surgery, and are wondering about financing options and insurance coverage, please contact our cosmetic surgery office today. We will be happy to work with you. Depending on what he finds during your initial examination, Dr. Rai might be able to write a letter to your insurance company explaining the health reasons for your procedure.