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Does Medical Insurance Cover Breast Reduction Surgery?

Going through a breast reduction procedure can be a very emotional experience for a woman taking into account how much difficulties and hurt large breasts might cause her. Breast reduction often isn’t done for cosmetic purposes. Large breasts are a real issue for some women; it makes them experience physical discomfort, including pain in the back, neck or shoulders, and, from the emotional point of view, it can affect her self-confidence. Therefore, today we explore the financial aspect of breast reduction surgery and specifically, the cases when insurance companies may consider breast reduction a medical necessity and cover the cost (or a part of it).

How Much Does Breast Reduction Cost?

Breast reduction procedure is a surgery that aims to reduce the size, fix asymmetry, and sometimes, correct the shape of the female breasts (concerns related to male breasts are addressed by another surgical procedure known as gynecomastia that is a breast reduction procedure as well).

The cost of breast reduction very much depends on a number of factors. These include, but are not limited to:

  • the type of settings (hospital or an outpatient surgical center),
  • geographical location,
  • qualification of the surgeon and the surgeon’s support team,
  • patient’s measurements, including height and weight,
  • other procedures combined with breast reduction (e.g. liposuction or breast lift), if necessary.

Usually, the cost of breast reduction surgery at Surgicare Arts & Aesthetics will range from $7,500 to $9,500.

To get a more precise estimate for you individual case, contact Dr. Angelina Postoev to book a consultation in order to consider all factors that might impact the final cost. We also provide flexible financing options to all our patients.

When a patient of Dr. Angelina Postoev gets  a quote, it includes everything from A to Z and won’t change afterwards creating unpleasant surprises. No unexpected anesthesia fee, hospital fee, facility fee, postoperative care fee or other additional costs will show up on your final bill.

FAQ: “Will My Insurance Cover My Breast Reduction?”

More or less, women with large breasts suffer from the same type of problems. Large and heavy breasts are often associated with chronic upper back pain, neck pain, shoulder pain, and arm pain. Shoulder straps of a bra supporting heavy breasts dig into shoulders leaving painful marks. Disproportionally large breasts often affect female posture. Daily activities of  the women are limited, too. Many of them complain of inability to exercise and difficulties sleeping. And of course, many women, especially young girls, feel very self-conscious.

Taking all of this into account, many patients ask the same question:

Is breast reduction a medical necessity addressing physical and emotional health issues, or is it a cosmetic procedure?

If it’s a medical necessity, medical insurance companies are supposed to cover the surgery cost or at least a part of it (depending on your plan and benefits). However, it’s not that simple. Here is why.

Any procedure must be qualified as a medical necessity in order to be covered by a health insurance company. Insurance companies have different terms and requirements for different health conditions. Therefore, the first thing one should do is checking these terms and conditions. This can be done by phone or online (on the official website of your insurance company).

Qualifying someone for a breast reduction surgery coverage, the specialists use a special chart that can tell whether or not a person requires breast reduction for medical reasons. This chart tells how much breast tissue can be removed to qualify the procedure as a medical necessity and reimburse its costs. Dr. Angelina Postoev explains the details in this video:

The chart that is often used by surgeons and insurance companies to evaluate a patient for breast reduction surgery is based on body weight and height. It additionally involves the weight of breast tissue that potentially needs removal. The results can provide an insurance company with pre-indications of whether or not to consider the patient’s reasons a medical necessity.

Another frequent factor in the coverage decision is the place where the breast reduction surgery is performed. The majority of insurance companies require that the procedure is performed in the hospital settings. All patients are different, and some patients have other health conditions to consider. Not everybody can get the surgery done in an outpatient surgery center.

At Surgicare Arts & Aesthetics, we do not accept insurance from patients interested in the breast reduction surgery. However, Dr. Angelina can refer a patient to a qualified plastic surgeon who accepts medical insurance.

Angelina Postoev, MD, FACS, a triple board-certified cosmetic surgeon, and Christopher Ibikunle, MD, FACS, offer breast surgery and other types of cosmetic surgery to men and women in Lawrenceville, Suwanee, Johns Creek, Buckhead, and surrounding areas of Atlanta, Georgia. Contact us today to schedule a personal consultation.

1 thought on “Does Medical Insurance Cover Breast Reduction Surgery?”

  1. Pingback: Breast Reduction FAQs: Expectations, Scarring, Breast Reduction With Lift

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