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Does Insurance Cover Breast Reduction Surgery?

Does Insurance Cover Breast Reduction Surgery?

At our Troy, MI area area plastic surgery practice, one question comes up during nearly all of our breast reduction surgery consultations: will my insurance cover my breast reduction surgery? Unfortunately, rather than there being a simple “yes” or “no” answer, a number of factors play into whether one’s insurance will cover breast reduction surgery. First and foremost, insurance companies will want to know the patient’s reasons for getting breast reduction surgery. More specifically, is the patient seeking breast reduction surgery for medical reasons, or is it simply a cosmetic choice?

At AMAE Plastic Surgery in Troy, MI area board certified plastic surgeon Dr. Ali aims to provide all of his patients with care that is not only above average in quality, but also as affordable as possible. In this article, we will discuss the specific process one must go through in order for their insurance to cover their breast reduction surgery.

Insurance Terms to Know for Breast Reduction Surgery

When dealing with insurance companies, it is common to encounter unfamiliar terminology. To begin, we’ll define a few common words and phrases that tend to come up when discussing breast reduction surgery with one’s insurance.

  • First up is exclusion. Exclusion simply refers to anything your insurance provider refuses to cover.
  • Next is reduction mammoplasty, which is simply the medical term for breast reduction surgery.
  • Macromastia is the name of a medical condition that causes the abnormal enlargement of the breasts. Many breast reduction surgery patients suffer from macromastia.
  • Finally, we have the Schnur scale. The Schnur scale is used to compare the surface area of one’s body to the amount of breast tissue being removed. Occasionally, insurance companies will use the Schnur scale when determining coverage for breast reduction surgery.

How To Get Breast Reduction Surgery Covered By Insurance

#1. Check If Your Insurance Has Breast Reduction Surgery Exclusion

If your insurance policy lists reduction mammoplasty (Breast Reduction) as an exclusion, this means your insurance will not cover the procedure. However, most insurance companies will NOT have Breast Reduction listed as an exclusion.

If it is not listed as a specific exclusion in your policy, then there is at least he potential for getting your breast reduction surgery covered by insurance.

#2. Carefully Document Why You’re Seeking Breast Reduction Surgery

Breast reduction surgery is commonly sought out by women whose breast size has caused them pain in the neck or back, or significant irritation of the skin, and/or impeded their ability to stand with good posture. The physical pain and other ways large breasts can interfere with everyday life is known as symptomatic macromastia. Whether or not the patient is experiencing symptomatic macromastia will play a critical role in their insurance company’s decision.

One way of determining if you have symptomatic macromastia is whether the size of your breasts has led to you undergoing any other kind of medical treatment. This could include visits to orthopedic surgeons, internal medicine doctors, chiropractors, physical therapists, or massage therapists.

#3. Schedule a Breast Reduction Surgery Consultation With a Board Certified Plastic Surgeon

During your consultation with board-certified Troy, MI area plastic surgeon Dr. Ali, you will first be asked a series of detailed questions regarding the negative impact your large breasts have had on your life. Dr. Ali will help determine whether your breast reduction surgery is motivated by medical reasons or cosmetic reasons.

While many women visit our Troy, MI area practice simply for cosmetic breast reduction surgery, such procedures are considered self-pay; meaning it will not be covered by insurance if it is only sought for cosmetic reasons. However, if we agree that you need breast reduction surgery for medical reasons and are an appropriate candidate for insurance coverage, our staff will gladly help guide you through all necessary paperwork.

#4. Wait for the Breast Reduction Surgery Insurance Determination

Once all applicable paperwork has been submitted to the insurance company, patients must wait for a response from their insurance provider. Ideally, when the patient provides valid medical reasons (supported by well-documented symptoms), the insurance company will approve coverage of the patient’s breast reduction surgery.

Occasionally, however, the insurance company will still deny coverage for breast reduction surgery. While this can be a frustrating bump in the road, patients still have another viable option. At AMAE Plastic Surgery in Troy, MI area, many of our breast reduction surgery patients were initially denied coverage for their procedure. In such cases, patients are able to submit an appeal.

#5. Appeal a Breast Reduction Surgery Insurance Denial

After being denied coverage for breast reduction surgery, patients have the option of submitting an appeal. This entails providing the insurance company with additional information and documentation regarding the patient’s condition. When one’s insurance request is denied, it is often simply because the insurance company requires more information pertaining to the adverse impact the patient’s breast size has had on their quality of life.

At AMAE Plastic Surgery in Troy, MI area, we will gladly help our patients obtain further documentation, while reminding patients that the more evidence they can provide their insurance, the better. For example, if the patient’s breast size has required the treatment of other healthcare professionals, letters of support from such individuals can be greatly beneficial.

#6. Schedule Breast Reduction Surgery!

As soon as the patient has been approved by their insurance, the next (and final) step is to schedule their breast reduction surgery. And while board-certified Troy, MI area plastic surgeon Dr. Ali shares in his patients’ hope for their insurance to cover their breast reduction surgery, his priority is for patients to get the care they need with minimal financial strain. For this reason, AMAE Plastic Surgery also offers two convenient financing options to anyone denied insurance coverage for their breast reduction surgery.

Insurance Covered Breast Reduction – Troy, MI area

Figuring out your insurance coverage can be as daunting as it is confusing. But by following the above tips and navigating the process one step at a time, not only is it possible for your insurance to cover your breast reduction surgery, it’s surprisingly likely.

Symptomatic macromastia can cause enough physical neck pain as it is. Don’t subject yourself to the pain in the neck that is dealing with insurance companies. Contact AMAE Plastic Surgery in Troy, MI area today, and let us help you get the insurance coverage you deserve for your breast reduction surgery!

Breast Reduction Consultation – Troy, MI Area: 248-335-7200