Will insurance cover breast reductions? For many women, the goal of undergoing breast reduction surgery is to alleviate unwanted symptoms caused by their breast size. In these cases, the patients tend to believe that the procedure is reconstructive rather than cosmetic and as a result, insurance should cover it. Unfortunately, however, this is not always the case. Breast reduction is generally considered to be a cosmetic procedure by most insurance companies. In some circumstances, insurance may cover the cost of the procedure. We outlined what you will need to show your insurance company to have your surgery covered. Read on to learn more!

What is breast reduction surgery?

Breast reduction surgery, medically referred to as reduction mammaplasty, helps women who suffer symptoms from overly large breasts. Many women develop back, shoulder, and neck problems due to their breast size. In addition, some find everyday tasks difficult or suffer from constant rashes or nerve pain. Breast reduction surgery can help in these specific cases. In this procedure, the surgeon removes excess fat, skin, and tissue to achieve the desired cup size.

How much does a breast reduction cost?

The cost of breast reduction surgery varies. There are many factors that influence the cost of the procedure. These factors fluctuate based on the location of your surgery as well as the years of experience and expertise of your doctor. Below are the factors you should consider.

  • Anesthesia costs
  • Location of the procedure
  • Hospital costs
  • Doctor’s fee
  • Medical tests

According to statistics from the American Society of Plastic Surgeons from 2018, the average cost of a breast reduction is $5,680. However, this number only reflects patients who had breast reduction for aesthetic purposes.

Will my insurance cover breast reduction surgery?

As mentioned, most patients believe that if surgery is considered reconstructive or medically necessary, it will be covered by health insurance. In the same vein, if a procedure is considered cosmetic, it will not be covered.

In the case of breast reduction surgery, most insurance companies consider it to be a cosmetic procedure. This can change if the patient can prove that they suffer from many health issues. The patient must also prove that she attempted multiple other ways to fix those issues prior to undergoing corrective surgery. If you make a strong enough case to your insurance company, it may then be considered a reconstructive procedure. As a result, the company will cover your procedure.

It is important to note that this is becoming rarer and rarer. Every insurance company has a different set of standards that would deem the surgery reconstructive. This inconsistency makes it difficult for plastic surgeons to know if they can help their patients receive this financial relief.

To know for sure if your insurance carrier will cover your procedure, call a representative. He or she can talk you through the carrier’s specific requirements for covering breast reduction. On average, it takes between three to six months of preparation with your insurance carrier to have it covered. This might include mandatory secondary consultations with other healthcare providers to confirm that the procedure is medically necessary. It could also include physical therapy or chiropractic care to qualify for insurance coverage for breast reduction.

If insurance covers the procedure, you will still be responsible for the deductible and any copays.

Quick tips for breast reduction insurance coverage

  • Read your insurance coverage materials. The carrier’s online resources for your particular level and type of health insurance coverage will clarify if the procedure can be covered.
  • Reach out to your insurance carrier. While doing your own research is important, don’t depend solely on your own interpretation of the carrier’s rules. Call your insurance company and see if pre-approval is required for breast reduction surgery. Find out what documentation your insurance carrier requires from your physician to establish medical necessity. In addition, if a second medical or surgical opinion may be necessary before approving coverage for your breast reduction. Finally, ask if the carrier must choose the physician for your second opinion.
  • Find out about in-network vs. out-of-network doctors. Having a surgeon that you trust performing your breast reduction is crucial to a successful outcome that you will love. However, if you have a network restriction that limits your choice of surgeons, you might want to find out if you can use the plastic surgeon of your choice. Some companies allow out-of-network procedures at a reduced rate of coverage, while some companies disallow out-of-network care in non-emergency situations.

Berlet Plastic Surgery Can Answer Your Questions

Dr. Anthony Berlet performed hundreds of breast reduction surgeries over the past 20 years as a top plastic surgeon in New Jersey. Along with his team of caring staff, Dr. Berlet aims to answer every question and address every concern of his patients before performing any procedure. Your comfort is most important for our team.  If you have questions about breast reduction and insurance, reach out to us today to learn more! We would be happy to answer your questions and schedule an initial consultation.