Breast Reduction and Insurance: Ensuring Coverage for You Marotta Plastic Surgery Specialists

Breast Reduction and Insurance: Ensuring Coverage for You

If the weight and size of your breasts have you feeling self-conscious or overwhelmed, rest assured that the adept plastic surgeons at Marotta Plastic Surgery Specialists can offer a solution through breast reduction surgery.

A large number of women consider reducing their breast size but may be unsure about their options or the affordability of the procedure. Fortunately, there are various possibilities to achieve a more typical, less burdensome breast look, and in many cases, medical insurance may cover the procedure. Continue reading for further details.

Are you a candidate for Breast Reduction Surgery?

The surgical process of breast reduction surgery, also referred to as reduction mammoplasty, stands as an option accessible to Long Island women dealing with excess breast tissue and skin, which can be eliminated to diminish breast size. Those with substantial or exceedingly large and weighty breasts (macromastia) often face physical and psychological limitations. Everyday activities like finding fitting clothes or concerns about people's attention can significantly impact well-being. Simple tasks, such as wearing a seatbelt, sleeping on the stomach, and engaging in physical activities like running or playing golf, can become challenging for women with ample breast sizes.

Finding Relief

Breast reduction surgery presents a viable solution to address these issues. Besides addressing the sagging that accompanies the aging process, this surgery can alleviate various health concerns related to carrying large breasts:

• Poor posture, leading to head, shoulder, and neck pain.
• Skin irritations beneath the breasts due to continuous friction with the abdominal area.
• Imprints on the skin caused by bra straps on the shoulders.
• Difficulty in breathing or limited lung capacity caused by the weight of large breasts affecting the chest region.
• Hindered capacity for physical activity, potentially contributing to weight gain.

Given these health considerations, it is reasonable to explore the possibility of health insurance covering or partially covering breast reduction surgery, enabling you to lead a healthier and more comfortable life.

Is Breast Reduction Surgery covered by insurance?

Breast reduction surgery is among the few select cosmetic procedures that some health insurance providers may consider for coverage. While specific requirements may vary depending on the insurance company and specific insurance plan, your insurance may cover the procedure if you experience the following:

• Breasts of considerable size that could be lessened by a minimum of three cup sizes or more (equivalent to around 500g or approximately 1.1 lb.).
• Persistent neck, head, back, or shoulder discomfort despite consistent consultations with a physical therapist.
• Dermatological issues, like painful "grooves" from bra straps or rashes beneath the breasts, that cannot be adequately treated without breast size reduction.
• Incapacity to sustain a weight that is healthy due to restrictions in engaging in physical activities or sports, attributed to breast proportions.
• Documented evidence that weight loss failed to alleviate the burden of large breasts.

For insurance pre-authorization, it's essential for your Long Island plastic surgeon or general practitioner to submit a letter detailing these matters to your insurance provider. Most insurance carriers require two letters of medical necessity documentation. Some individuals who possess the means to privately finance the procedure may opt to do so without seeking insurance pre-authorization. They may choose to proceed with the surgery first, allowing them more freedom in selecting a plastic surgeon and determining the amount of breast tissue or weight to be removed, as certain insurance policies may require specific criteria for approval. Subsequently, photographic evidence of the before and after results, along with a description of the health issues experienced, can be submitted to the insurance company.

Steps to Secure Coverage

Unless you are capable of privately funding the breast reduction procedure, we recommend taking the following steps before undergoing the procedure to explore your insurance coverage options:

• Examine your insurance plan to determine whether the procedure will receive full or partial coverage to address your symptoms.
• Contact your insurance provider and inquire about the necessity for a letter giving pre-authorization for breast reduction surgery.
• Understand the documentation required by your primary doctor or plastic surgeon to qualify for partial or full coverage.
• Confirm if your insurance provider mandates a second opinion or a medical assessment from a second general practitioner or plastic surgeon to ensure coverage.
• Determine if you are required to use a plastic surgeon chosen by them who is in-network for full or partial coverage, or if you have the flexibility to choose your own doctor. The selection of the appropriate doctor or plastic surgeon for the procedure, as well as any other cosmetic surgical procedure, is a pivotal part of the process.

In summary, it's fortunate that breast reduction surgery might potentially qualify for health insurance coverage in certain scenarios or for a significant number of cases. Although health insurance usually excludes coverage for cosmetic surgical procedures, except in instances of accidents, injuries, breast cancer treatment reconstruction, or congenital deformity correction, there are specific circumstances where breast reduction surgery could be considered. If the procedure markedly enhances a woman's quality of life or helps alleviate health problems linked to large breasts, it can become a viable option to explore with your health insurance provider.

If you are interested in scheduling a consultation regarding breast size reduction with one of our Long Island board-certified plastic surgeons at Marotta Plastic Surgery Specialists, we encourage you to contact us today for more information or learn more about the procedure on our breast reduction page.