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Breast Reduction Surgery and Health Insurance Coverage (Q&A)



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my name is Eric Chang I'm a plastic

surgeon

I practice here at Howard County General

Hospital my name is dr. Sarah mess and

I'm a board-certified plastic surgeon my

office is in Columbia Maryland next to

Howard County General Hospital breast

reduction surgery is covered by

insurance there is a set of criteria you

need to make first you need to call your

health insurance company and ask them if

they cover the breast reduction surgery

the code for it is one nine three one

eight sometimes your human resource

department at work does not include that

code under your benefits so that's the

first thing you need to determine most

patients have at least a double D cup

size breast because a pound or more of

tissue needs to come off of each side

women sometimes get a little confused

between a breast lift and a breast

reduction some women come to see me and

they think they want a breast reduction

when in fact what they want is a breast

lift a breast lift is similar to a

breast reduction but you're actually not

removing any tissue so you're actually

rearranging the tissue your lift

obviously lifting the tissue you're

bringing in the breast up to a better

more natural position unfortunately a

breast lift is considered a cosmetic

procedure it's not it's not at all

covered by insurance there's no

reconstructive aspect to it

if you are interested in having a breast

reduction surgery and you have back pain

neck pain or shoulder pain I would make

sure you tell your regular doctor that I

would make sure they documented in their

regular note their regular visit often

the insurance company wants to know

whether you've had a trial of something

like motrin on a regular basis to see if

that has helped your neck pain if that

doesn't work often they want you to see

a physical therapist there's a lot of

Hoops that they want you to jump through

if you have had a physical therapist and

have had an appointment with them make

sure that your regular doctor gets a

copy of that note often you need all

that data put together all that

information put together in your file to

actually make us all in case for the

fact that you need a breast reduction

surgery medically covered depending on

your insurance company you will need a

prior pre-authorization or

predetermination of breast reduction

surgery this is a process that that is

done by your plastic surgeon we need to

have your date of surgery and place a

surgery and estimated weight that we're

going to remove as well as your height

and weight your bra size and photographs

supporting documents are also sent in

these supporting documents are from your

primary care and any other physicians or

healthcare practitioners that are

dealing with your musculoskeletal pain

related to your breasts so that could be

orthopedic surgeon it could be here

neurologist it could be your physical

therapist your chiropractor all these

notes are should be sent as well as

documentation if you needed to take

medication for rashes medication for

pain and so if you needed to appeal to

your insurance company for authorization

you will need to send them all of these

documents as well as a letter of support

requesting breast reduction surgery