How To Get Your Insurance To Pay For Breast Reduction? Step-By-Step Process

Helen Skeates
Helen Skeates
14 min read

A breast reduction may be covered by your insurance, but you want to know how to get it. If this is the case, ask the surgeon to draft a statement outlining your medical history and current state of health. This is an estimate of the weight of the breast to be surgically removed. This necessitates a response. This must be completed prior to the operation date.

A trip to the doctor is an absolute need. That way, you’ll know for sure whether or not you’re a good candidate for the procedure. In addition, keep in mind that the health of your breasts varies greatly from woman to woman. You should thus only discuss your issues and inquiries with professionals.

More details regarding the procedure and the insurance that will cover it are provided below.

As Medically Necessary

Breast reduction is often covered if it’s deemed medically necessary by the insurance company. Nevertheless, the patient has demonstrated to her doctor that the underlying issue ought to be pursued. Additionally, it would be beneficial if you remedied this through remedial action. The patient’s insurance must also meet a certain level before they can be admitted. There is a good chance that the procedure will be covered by the insurance.

Breast Reduction Surgery Be Like

An outpatient or hospital-based surgery setting will be used for the breast reduction procedure Incisions can be employed in a variety of ways, thus far. Your breast size, skin elasticity, and excess skin or sag will all be taken into consideration by the surgeon. After the procedure, you’ll need to wear a bra that provides support. This is how it will be till the bandages are taken off. Some doctors will allow you to stop wearing them beyond that point. That or only at a predetermined time.

Is breast reduction covered by health insurance? | ASPS

A comfortable bra can be worn immediately after you remove your dressings. Do not wear a bra for six weeks, including an underwire.

After returning home, you should expect a two- to six-week recuperation period. A good moment to ask for help with domestic duties is now. Physical exertion will be limited to lifting no more than 10 pounds for the next two weeks. Don’t do any strenuous activities or exercise for the next two weeks, either. You can do this by not extending over your head for two weeks, as an example. Increase your physical activity level over time. In the last four to six weeks, focus on strengthening your upper body. Immediately following the procedure, I snapped this photo.

Who Should Consider Breast Reduction Surgery

Most women undergo mammoplasty to alleviate pain and to achieve a more balanced breast size, although there are a variety of other reasons for doing so.

  • Anxiety-induced numbness
  • Poorly-fitting clothes, such as bras
  • Participation in certain activities is restricted.
  • Under the breast, there is a rash.
  • An excruciatingly painful back, neck and shoulder

Probable Risks Of Breast Reduction

Surgery to remove a woman’s breasts is a perfectly safe technique. Infection, healing, and bleeding complications are all difficulties that can arise during surgical operations. Breast reduction, on the other hand, may reduce them. There is the potential for the areola and blood supply in the nipple to be compromised by the procedure. There are a few exceptions, but this is an extremely unusual one. If you breastfeed, your milk production may be affected by the surgery. If you’re hoping to start a family, you’ll need to do this as well. Studies have shown that some women may need to supplement their breast milk with formula. It’s impossible to tell who will or won’t be supplementing. People who have had their breasts surgically reduced will still be able to produce breast milk. The formula will need to be supplemented by others.

Is breast reduction covered by health insurance?

It all depends on the situation. To qualify for health insurance coverage for breast reduction, a procedure must address a patient’s long-term health issues.

There is a good chance that you will first need to secure insurance approval for the breast reduction surgery. If you have health insurance, your insurer will ask your surgeon to submit documents on your behalf so that it can determine whether or not you need surgery. The procedure may be covered by your insurance, but you will be responsible for any copays or deductibles.)

Surgery to reduce the size of your breasts will not be covered by your health insurance if it is deemed aesthetic rather than medically necessary.

Ways To Get Your Insurance To Pay For Breast Reduction

According to the insurance business, the procedure of purchasing a policy differs greatly. Make it simpler on yourself by following the steps outlined below. Breast reduction surgery is covered by most insurance plans.

#1. Preparing a medical letter

Make sure you have a doctor’s note ready in case you need one. In most cases, you’ll have to supply this information to your insurance company. If the existing health issue can’t be resolved without this procedure, it must be stated here. A full six to twelve months’ worth of records will be required by the insurance companies. A dermatologist, a chiropractor, a physical therapist, and an orthopedist will all be involved in your care. This is to ensure that the procedures are in compliance with the regulations prior to the approval of the surgery.

How To Get Your Insurance To Pay For Breast Reduction? 3 Easy Ways! - Krostrade

#2. Writing a letter of request

Provide specifics in a letter requesting approval, such as a budget justification. This expedites the procedure by taking your insurance provider into account. Prior to the breast reconstruction operation, this must be submitted. This is necessary due to the stringent requirements of each insurance company’s approval process.

#3. Submitting required docs

A turnaround time of three to six months is typical for submitting the necessary paperwork. It is possible for an insurance company to meet with a physician during this time period. Getting a second opinion from a doctor or other healthcare professional can help with this. Chiropractors are one type of healthcare provider in this category. To ensure that the medical procedure is necessary, this will be done. Additionally, you must let the doctor know whether you want to have the treatment paid by your insurance. As a result, the doctor’s letter will be required. The insurance company will also receive further paperwork from you.

Things Expected During the Surgery

All breast reduction surgeries are carried out under general anaesthetic. It can also be done at an outpatient facility or a hospital. During the procedure, the surgeon will employ either one of the two approaches. Extra fat can be removed this way. The patient’s breast size, liposuction, or surgical incision are also included. You should expect the attending surgeon to make an incision all over your areola. Ring of pigmentation around the nipple is this. The fat, tissues, and skin are then removed as it continues down the breast.

This is the most effective way to minimize the size of the breasts as a whole. Before the areola is repositioned, the breasts will be reshaped once again. Consider the new and resized breasts while making this determination

While the areola is relocated, the breasts will be reshaped. A larger bust necessitates a larger cup size.

Do breasts have to be a certain size in order for you to be a candidate for reduction?

The size of your breasts isn’t very relevant when it comes to breast reduction surgery. The most important metric is the amount of tissue that will be removed during the procedure. Medically required” requirements may dictate that the surgery must remove a particular quantity of tissue before it is covered by your insurer.

According to some insurance companies, the Schnur Sliding Scale can be used as a benchmark. This is a weight-to-surface area ratio for a woman after she has had her breast tissue removed. Despite the fact that this computation is commonly used as a guide, it should not be taken as gospel.

If your Schnur ratio is higher than the 22nd percentile, your procedure is usually deemed required by doctors. It’s cosmetic if it’s below the 5th percentile. If your ratio is somewhere in the middle, your procedure may be classified as either medical or cosmetic, or as a combination of the two, and insurers may or may not allow it.

How much weight is removed in breast reduction?

It depends on your insurance provider’s understanding of what constitutes a “minimum” amount. For some, if less than 200 to 350 grams (7 to 12 ounces) of breast tissue is removed, the treatment may be deemed a breast lift rather than a breast reduction. This procedure is not covered by insurance because it is considered cosmetic surgery.

Other Conditions Covered By Insurance For Breast Reduction

Among the many cosmetic operations covered by health insurance are breast reduction surgeries. Some insurance plans and companies may have different criteria. As a rule of thumb, though, a woman should experience the following:

  • Pain in the neck, shoulders, back, or head that was not alleviated by frequent therapy visits
  • Large breasts can be shrunk by up to three cup sizes. 500 grams or more is possible.
  • The treatment and cure of dermatological problems such as painful grooves are both inadequate. Wearing two or more bras, as well as bra straps that support breasts that are large or rashes, can create these in the shoulders.
  • A person is unable to maintain a healthy body weight because to a lack of physical activity. It could also be the case that a woman refuses to participate in sports because of her large breasts.
  • Weight reduction has been observed, although it has no effect on breast size. There’s no better way for a woman to find the relaxation she’s been looking for!

Begin the process by submitting a pre-authorization letter. A general practitioner or plastic surgeon should handle this. This will necessitate the use of images to document things like the appearance of large breasts and skin irritations. Other people, who are able to afford the treatment on their own, can wait. They don’t ask for further pre-authorization from the insurance provider. Instead, they hold off on making a decision on the plastic surgeon until after the procedure has been performed. This will also help determine how much breast tissue or weight will be removed during the procedure.

A certain volume of tissue would be required to be covered by insurance coverage. The doctor or plastic surgeon will provide the insurance company with images of the patient before and after the procedure. Include any health problems you may be having.

How much does a breast reduction cost with insurance?

Breast reduction surgery comprises a number of components, including the cost of the procedure itself.

  • Pay for the doctor’s services
  • Costs associated with anesthesia
  • The price of care at a hospital
  • Medical examinations
  • After-surgery clothing
  • Medicines prescribed by doctors

According to the Aesthetic Plastic Surgery National Databank, the average plastic surgeon’s price for a breast reduction was $5,717 in 2020. However, fees can differ greatly based on the following factors:

  • The level of expertise of the surgeon
  • How a surgeon performs a breast reduction
  • Regardless of whether you have one or both breasts removed during surgery,
  • Market pricing in your geographic location

the cost of living in your area


$4,782 ($2,391 per breast) surgeon’s charge

$997.50 anesthesia costs

ambulatory surgery center facility costs $6,548

The outpatient hospital facility cost is $10,257.

Ambulatory surgical center bill: $12,327 in total

Cost Of Breast Reduction With No Insurance

You save money by having the breast reduction operation covered by your insurance. All you have to do is submit a valid insurance claim. The American Society of Plastic Surgeons compiled the data for this study. It costs an average of $5,482 to have breast reduction surgery. Additional costs such as these are also included:

  • Anesthesia
  • Expenses related to the use of a
  • After-surgery prescription drugs
  • fees for doctors

You might also be interested in learning how much a Breast MRI without insurance costs.

How can I finance a breast reduction?

Medical finance solutions, including as payment plans, are available from a wide range of plastic surgery providers. CareCredit, a medical credit card, is widely accepted by many. For a limited time, CareCredit offers no-interest financing to customers who pay their balance in full within a specified timeframe (6 to 24 months). However, if you don’t, you’ll be hit with interest charges at a high APR of 26.99 percent.

Loans for cosmetic surgery are available from several online lenders. Prosper Healthcare Lending loans feature interest rates ranging from 7.95 percent APR to 36.00 percent APR for a maximum of 60 months.

Steps to Take to Get Your Breast Reduction Covered by Insurance

There is no need to utilize a healthcare-specific loan or credit card to pay for a breast reduction procedure. Shop around for the best deal on a low-interest loan or credit card. Credit card APRs in the United States average less than 15%.

It’s A Wrap!

To ensure that your insurance will cover the cost of a breast reduction, follow the advice provided. After that, you may focus on living your life to the fullest by having your sagging or large breast tissue removed. You won’t have to worry about anything because everyone here is friendly and helpful. Get in touch with a breast reduction specialist and set up an appointment. A Bactrim and Penicillin without insurance may be of interest to you, as well.

Helen Skeates

Helen Skeates

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum.