Breast reduction surgery is a common surgical procedure that has a multitude of physical and emotional health benefits. Getting a breast reduction can often be considered a medical need, as having large breasts can cause unnecessary discomfort and pain. While many people are interested in getting their breast size reduced, they may not be sure what their options are or if they can afford it. Luckily, mammoplasties can be covered by medical insurance in many cases. Keep on reading to learn more about how to get a breast reduction surgery covered by your health insurance.
Key Takeaways
- A breast reduction surgery (or mammoplasty) is a surgical procedure that removes excess fat, tissue, and skin from the breasts to reduce their overall size.
- Breast reduction surgeries are covered by health insurance in many cases, as they can often be considered a medical need.
- The average cost of this surgery is $5,475, but anesthesia and surgeon fees, inpatient services, post-surgery items, and prescriptions can raise the cost up to $18,000.
- Many insurance companies will cover breast reduction surgery only if a patient exhibits a medical need for it.
What Is Breast Reduction Surgery?
A mammoplasty, commonly referred to as a breast reduction surgery, is a surgical procedure that removes excess fat, tissue, and skin from the breasts to reduce their overall size. While some people may opt for breast reduction surgery as a cosmetic enhancement and a boost to their self-confidence, many are interested in the procedure’s physical health benefits. Having large breasts can cause excessive pain and/or discomfort that has an impact on overall health. There are several reasons why someone may want or need a breast reduction, including:
- Neck, back, and shoulder pain
- Skin irritation underneath the breasts or on shoulders due to bra straps and chafing
- Inability or limited ability to participate in physical activities, such as running and exercising
- Labored breathing or inhibited lung capacity
- Posture problems
- Poor self-image
Many individuals with large breasts suffer from a combination of these issues, but may not be able to afford breast reduction surgery. The average cost of this surgery is $5,475, but anesthesia and surgeon fees, service location, inpatient services, post-surgery items, and prescriptions can raise the cost up to $18,000. When someone who is in need of this surgery is unable to receive it, it can have damaging physical and psychological effects on their well-being.
When Will Insurance Cover Breast Reduction Surgery (Mammoplasty)?
Fortunately, many insurance companies will cover breast reduction surgery if a patient exhibits a medical need for it. Although rules vary between insurance companies, insurers will typically consider covering a mammoplasty if any of the following apply:
- A patient’s breasts can be reduced by at least 3 cup sizes or 500 grams of weight
- Head, neck, and shoulder pain is too severe to be treated by a physical therapist
- Issues with skin irritation or rashes cannot be properly treated without a breast reduction
- A patient cannot maintain a healthy body weight due to a limited ability to exercise
- Documented weight loss did not aid in pain relief or a reduction in breast size
Each insurance company has different coverage rules when it comes to breast reduction surgery. This type of surgery will generally be interpreted as a cosmetic procedure and will only be covered if a patient can prove that their breasts have caused an underlying health condition that can only be treated with a mammoplasty.
In order to prove this, patients will have to provide their insurer with a letter of medical necessity from a medical practitioner. Many insurers will request 6-12 months documentation of medical updates, including progress reports on pain and proof treatment from chiropractors or physical therapists. For specific information on what your insurance provider needs in order to approve a breast reduction, you can request a letter or directly call to find out what is required before coverage becomes available. It’s common for insurers to wait a few months before approving the procedure so they can assess other possible treatments and the level of necessity.
Who Is More Likely to Be Denied Mammoplasty Coverage by Their Insurer?
A patient is more likely to be denied mammoplasty coverage if any of the following apply:
- They have no documentation of an underlying health condition caused by the size of their breasts
- They have no previous medical treatments or consultations concerning their breasts
- They have never visited a chiropractor, physical therapist, or orthopedic in relation to their breasts
- They want to undergo breast reduction surgery purely for cosmetic or aesthetic reasons
What Can You Do If Your Insurance Won’t Cover Breast Reduction?
If your insurance provider denies coverage but you feel that a mammoplasty is necessary to your health, you are entitled to appeal. The appeals process should be detailed in the denial letter you receive. In many cases, there are multiple levels of the appeals that you can pursue. Letters from your physician or other medical practitioners, as a well as your own letter describing your experiences and physical symptoms can greatly impact an insurer’s decision. You can also submit updated scientific information on the benefits of mammoplasties.
As far as paying for breast reduction surgery, there are affordable noninsurance options available to those who prefer not to appeal. If your need for a mammoplasty is not immediate, you can consider saving enough money to pay for out-of-pocket costs. You may also consider paying by credit card, as many credit companies will offer various incentives and points programs that provide cashback. The most popular option is beauty financing. Several companies offer credit cards specifically for surgical and non-surgical cosmetic procedures. They offer monthly payment options and typically do not require upfront costs, so you can undergo a breast reduction surgery without the long wait and documentation that is associated with insurance coverage.
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