How to Get Breast-Reduction Surgery Covered Under Your Health Insurance

by Contributor ; Updated October 25, 2017
Your breast-reduction surgery may be covered under your health-insurance plan.

Breast reduction has become a popular procedure for women who desire smaller, more shapely breasts. There are many reasons you may wish to reduce your breasts, including back problems, chest pain, infections, difficulty breathing, uneven breasts or longing for a more firmer appearance. Breast-reduction surgery can be expensive, but in some cases your insurance company may cover it.

Step 1

Talk to your family doctor about breast-reduction surgery. Your doctor can not only recommend good places to have the surgery done, but also help get your insurance to cover the procedure if it is possible. Many insurance companies will cover a breast-reduction surgery if your large breasts cause medical problems, such back trouble, bad posture, skeletal deformities, or chest pain. Usually, all your doctor needs to do is either call the insurance company to get authorization for the breast reduction and give medical reasons that make it a necessity, or fax a copy of your medical record with reasons you need the breast reduction done.

Step 2

Call your insurance company yourself to find out what benefits are available. You may already have coverage for a breast reduction procedure through your current insurance company. Sometimes, finding this out and getting the breast reduction covered is just a matter of contacting the insurance company yourself. Ask them about breast reduction and what types of surgical procedures they are willing to cover. After that it may just be a matter of providing your insurance company with documentation of why you require the breast-reduction surgery. If you have medical issues that require breast reduction to remedy the problem, most insurance companies will pay for the procedure.

Step 3

Speak to a surgeon who you want to perform the breast reduction. Find a facility or a few that you are interested in where you may consider having the surgery. Ask them about what types of insurances they accept and what insurances usually cover a breast reduction procedure. Most cosmetic surgery facilities will know this information because they have experience dealing with insurance companies. Each insurance company requires a certain amount of criteria in order for a patient's breast reduction surgery to be covered. The facility where you choose to have the breast reduction done will know this criteria or have a billing associate that can check for you.

Step 4

Find out about the copay or deductible. A copay is usually a certain amount of the bill that you'll have to pay after (or before) the insurance company pays a certain percentage of the procedure. A deductible is the amount you must fulfill out of pocket before the insurance company comes in to pay any amount. Find out ahead of time what types of payments you will have to make in order to get your insurance company to cover the cost of a breast reduction. For example, some insurance policies will pay 100 percent of the breast surgery. Some insurance companies will pay up to 80 percent and require you to pay 20 percent. Make sure you know up front any fees associated with having your insurance company pay for the breast-reduction procedure.

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