Insurance Coverage and Breast Reduction Surgery: What You Should Know

By Sheryl Pilcher on August 06, 2015

A woman covering her breastsHere at Accent Plastic Surgery, we feel that the patient and his or her needs is a top priority. It's this strict focus on the patient that makes us one of the least cosmetic skin care and plastic surgery centers in San Antonio.

Not all procedure are simply in cosmetic in nature, however. Breast reduction surgery (reduction mammaplasty) can be performed for health needs, which opens up the possibility of insurance coverage for this particular procedure.

Can breast reduction be covered by health insurance?


Even though breast reduction may be an elective procedure for some patients, there are instances in which a breast reduction may be medically necessary. In these instances, it must be demonstrated that the size of a woman's breasts affects general wellness in some fashion, resulting in pain, discomfort, or other kinds of problems that have an impact on quality of life. When this can be demonstrated, a breast reduction procedure can potentially be covered by health insurance.

Issues with Body Pain Related to Breast Size

In some cases, the size and weight of a woman's breasts result in various kinds of aches and pains. The most common example of this is lower back pain caused by the excessive weight of very large breasts. In addition to lower back pain, it's possible for a woman to experience shoulder pain or neck pain given how the weight of the breasts can affect undergarments and certain kinds of tops. Over a long period of time, this pain can be significant given the steady and consistent wear and tear on the body.

Meeting with General Practitioner About This Matter

If you do experience pain as a result of excessively large breasts, it's important that you meet with your general practitioner. Your doctor will be able to advise you on whether breast reduction surgery is the best option to alleviate your pain, or if there are potential non-surgical solutions to consider. Your doctor will need to provide a statement about the medical necessity of the procedure for your insurance company.

Planning Treatment with Plastic Surgeon

If breast reduction surgery is the best option for your needs, you will then need to meet with a plastic surgeon to devise a treatment plan. For insurance providers to cover the breast reduction procedure, a certain amount of breast tissue will have to be removed. Your plastic surgeon will be able to devise a treatment plan for the breast reduction that meets the requirements, and this will be part of what you need to submit in order to have your surgery approved for coverage.

Check with Your Insurance Provider About Requirements

Insurance providers all differ, which is why it's imperative that you check with your insurance company and whether or not breast reduction would be covered. From there, be sure to check on the exact requirements, including any documentation necessary and other paperwork that may need to be filed.

How Our Team Can Help You

This process of gathering documents and making the proper filings can be stressful, which we fully acknowledge. Our team will be as accommodating as possible, helping you get all the information and official documents necessary so that your insurance claim goes through without a hitch.

Learn More About Breast Reduction Surgery

To learn more about breast reduction surgery and how it can help you alleviate body pain of different kinds, be sure to contact our cosmetic plastic surgery center today. Dr. Sheryl Pilcher and her team will work with you to get all the information that you need.

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If you need breast augmentation or any cosmetic surgery, I would highly recommend Dr. Pilcher....This has been the best decision I have made. Quintessa M.

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San Antonio Office

255 E Sonterra Blvd
Ste 201
San Antonio, TX 78258

More Info Directions (210) 654-9900