Large breasts, although attractive from the outside, can cause different health problems. Back, neck, and lumbar pain are the most common health problems at this point. It is possible to get rid of this problem permanently with breast reduction surgery, also known as mammoplasty.
Do you want to have breast reduction surgery, but postpone the surgery because you think your insurance won’t cover it? You don’t have to worry about whether my insurance will cover breast reduction surgery. Health insurances do not normally cover aesthetic procedures, but when it comes to breast reduction, there is a way.
How is the insurance process handled in breast reduction surgery? What does it take to cover your operation? All the details are in our article.
Table of Contents
Is Breast Reduction Surgery Covered by Insurance?
Whether breast reduction surgery is covered by health insurance is entirely related to the person’s condition. As it is known, health insurance covers such treatments by paying for the interventions that need to be done in terms of health. But it does not pay for other procedures, namely cosmetic surgery.
This requires you to plan for breast reduction surgery. To find out if the procedure is covered by insurance, your insurance company will request a number of documents from your surgeon.
If, as a result of these investigations, it is understood that the procedure was carried out due to chronic pain and other health problems, your insurance company will make the payment.
When it is decided that the breast reduction surgery is not performed for a medical necessity, the procedure is considered as an aesthetic operation. Accordingly, no payment is made. Therefore, the person must bear the costs himself.
In Which Health Problems Does Insurance Cover the Breast Reduction Procedure?
Breast reduction surgery can be referred to as one of the few cosmetic procedures that will be covered by health insurance. The coverage of your health insurance may vary. Therefore, there may be differences in the situation of meeting breast reduction. But if you have the following symptoms, it can be said that your insurance will largely cover the breast reduction procedure:
- Chest Body
Breasts that are subject to reduction to at least 3 sizes or more.
- Physical Pains
Neck, back and shoulder pain that does not decrease and does not go away despite regular physical therapy
- Dermatological Problems
The occurrence of grooves caused by bra straps and the inability to correct such problems without breast reduction procedure.
- Restriction of Physical Exercise
Not being able to exercise due to breast size and experiencing different health problems depending on the inability to exercise.
- Problems with Weight Loss
Breast size does not decrease despite documented weight loss.
Important Information: In order for the transaction to be covered by insurance, the necessary documents must be given to your insurance company for pre-authorization. These documents may include photos that show skin problems, skin rashes, and what the breasts look like. Some patients make the payment themselves because they don’t want to wait for the insurance company’s approval. After the examination, they are informed about which plastic surgeon they can choose and how much of the breast tissue will be removed. After the procedure, your doctor may send before and after photos to the insurance company.
Things to Do Before the Procedure to Learn Insurance Coverage
If you want to have the breast reduction procedure covered by insurance, there are some steps you need to take before the procedure. It is possible to list them as follows:
- Examine your insurance policy in detail to fully or partially understand the full or partial coverage of the procedure to be performed to eliminate the symptoms you are experiencing.
- Find out what documents are required to be issued by your regular doctor or plastic surgeon to evaluate full or partial insurance coverage.
- Contact your insurance company to see if a pre-authorization letter is required.
- Check to see if your insurance company has asked for a second opinion from a different doctor or plastic surgeon to cover the procedure.
- Find out if it is mandatory to choose the doctor that the insurance company has found for partial or full payment. Remember that the right plastic surgeon is of great importance for the success of the procedure and permanent results.
Keep in mind that each of the points included here is very important. Consider that the answers are important for the question of whether my insurance will cover my breast reduction surgery.
Need to Know
Other points to be known in this process are as follows:
- Health insurance normally does not cover the breast reduction procedure cosmetically. However, it may include some cases to eliminate medical problems that arise due to large breasts.
- Insurance companies have different practices in terms of whether breast reduction surgery is a medical necessity or not.
- In order to be covered by insurance, chronic and medical health problems caused by breast size must be documented.
Do Your Breasts Need to Be a Certain Size in Order to Be a Breast Reduction Candidate?
The size of the breasts is considered important for the operation to be covered by insurance. But the main point here is not the size, but the amount of tissue. The amount of tissue to be removed may be among the medically necessary criteria of your insurance company.
Schnur Sliding Scale is used by some insurers as a reference source. This reference is the ratio of the amount of breast tissue removed to the total body surface. The point in question may be expressed as a general criterion, but it may not always be considered valid.
Typically, patients should have a Schnur rate of more than 22%. This ratio indicates that breast reduction surgery is a medical necessity, not a cosmetic procedure. A lower rate may ensure that part of the transaction to be carried out is covered by insurance.
How Much Does Insured Breast Reduction Cost?
According to the data of 2020 in the National Data Bank of Aesthetic Plastic Surgery, the average cost of breast reduction surgery is $ 5,700. These figures are much higher in countries such as the US and UK. These fees vary according to a number of factors. These elements are:
- Surgeon’s level of expertise and experience
- Methods and techniques used in surgery
- Market prices at the location where the transaction is made
- Whether the procedure will be performed from a single breast or two breasts
Related considerations are highly influential on breast reduction prices.
What Affects the Fee to be Covered by the Insurance?
The fee that the insured will pay for breast reduction varies according to different factors. Therefore, it is quite difficult to give a clear figure about the price. These elements are generally as follows:
- Surgeon fee
- Medical tests
- Postoperative clothing
- Hospital expenses
- Prescribed medications
Depending on these, significant changes in costs may occur.
In Cosmeticium there are no such additional costs. All of them are included in the treatment package. You can contact via Whatsapp by clicking on the picture below to get free consultation and price.
How to Get Approval Under Insurance?
Insurance companies look for different terms to recognize that breast reduction surgery is a medical necessity. It would not be wrong to state that the most important element at this point is the amount of tissue to be taken from the breasts. In this regard by large insurance companies, some criteria are basically set, depending on the height and weight of the patient.
Today’s insurance companies focus not only on the amount of tissue removed, but also on the symptoms in the patient. Rashes on the skin, back and neck pain are important symptoms at this point. In addition, insurance companies accept the procedure performed on breasts that shrink less than two sizes as breast reduction, but as breast lifting. It does not pay accordingly.
Getting breast reduction surgery covered by insurance can be a complex and lengthy process. Your insurance company may ask you during this process:
- Medical symptoms due to large breasts and a doctor’s report showing how long they have been experienced
- Your height and weight
- Previously tried medical treatments for the problems experienced and their results
- Photos of breasts
Records You Need to Submit
There will be some records that you will need to submit during this process. These can be listed as follows:
- Doctor’s reports showing that non-surgical methods do not work
- Doctor’s letter showing when and for what periods non-surgical methods are applied
- Chronic and medical problems caused by large breasts
There are some insurance companies that argue that weight loss alone can cause breasts to shrink. These require the person to be at 20% of their ideal body weight so that the transaction is covered by insurance. However, considering that weight loss is difficult and unrealistic, the necessity is criticized by academics and experts.
The most important aspect at this point is to communicate with your insurer as well as possible. At the same time, it is to learn the requirements and conditions for this process in detail. Since the practice of each insurance company can be different, it is much more accurate to prepare documents by learning such information from the primary source.
When is it covered by insurance?
Your doctor who makes the decision to have breast reduction may indicate that it is a medical necessity. If it says you’ll be fine for your health and overall condition, your insurance can cover the cost of the surgery. Large and heavy breasts that cause chronic pain and different health problems are considered the medical justification at this point. If you have the following symptoms, you may be covered by insurance:
- Back pain
- Shoulder pain
- Neck pain
- Skin rashes
- Skin irritations
- Migraine headaches
- Intense sweating under and around the breasts
- Numbness in the fingers and hands
- Limitation of exercise
- Different underlying causes from the type of rheumatoid arthritis
Apart from these, your doctor may also need to provide some documents for the insurance company to approach your claim positively.
Expenses To Be Spent By You
You may have medical grounds for your breast reduction surgery and be accepted by your insurance company. But keep in mind that there may be some costs you have to pay. Your insurance generally covers all or most of the hospital fees. On the other hand, you can cover the surgeon fee, assistant fee and anesthesia fees to a significant extent. You may have a chance to get a discount for these costs.
There are some quick tips to consider as to the answer to the question of whether my insurance company will cover my breast reduction surgery. These can be listed as follows:
- You should read the materials on insurance coverage carefully. Thus, it becomes clear to a certain extent whether your insurance company will meet the transaction to be made, and if so, at what rate.
- You should contact your insurance company. At this point, your own research is of course important. But each company’s practice can be different. Therefore, you should contact your insurance company and inquire about whether pre-approval is required. You can find out in detail the documents required in this process, how the process progresses, how long it takes for the approval to be issued, whether an opinion will be requested from a second doctor.
- You should collect information about surgeons online and in the real world. Choosing an experienced and successful surgeon in the field is of great importance in terms of obtaining a successful result. If there is a situation that restricts your choice of surgeon, you need to find out if you can use your preferred plastic surgery. At this point, some insurance companies only allow surgeons outside the network in case of emergency, while others do not make a restriction at this point. You need to learn your insurance company’s position on this point.
Schedule a Consultation
If you are also considering breast reduction but are worried about it, you should first find an experienced surgeon in this area. Your preferred experienced surgeon will give you the answer to the question of whether my insurance company will cover the costs of the surgery.
As COSMETICIUM, we know which procedures insurance companies consider to be a medical necessity. Both our expert staff in this field and our plastic surgeons meet your expectations in this field at the highest level. You can contact us now for more information and a free online consultation.
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