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Is breast reduction surgery covered by insurance?

 

Is breast reduction surgery covered by insurance?Oversized breasts can sometimes cause persistent discomfort and pain, and may also interfere with activities and movement. Breast reduction cosmetic surgery is a safe and effective procedure that can address excessively large breasts to eliminate these medical issues. In such cases, insurance coverage may be available for breast reduction surgery.

The Aesthetic Center for Plastic Surgery (ACPS), led by board certified plastic surgeons, provides breast reduction to patients in Houston, Texas, TX, and surrounding communities.

Possibility of Insurance Coverage

Oversized breasts or symptomatic macromastia is a recognized health condition that may require therapeutic management, and even breast reduction plastic surgery. Heavy breasts impose various medical constraints on the patient. Therefore, breast reduction surgery may sometimes be as necessary as, say, a cervical spine or shoulder surgery.

But if the patient is considering breast reduction surgery only for cosmetic reasons and does not experience any major physical discomfort, then the insurance company will not cover the procedure. In such instances, the insurance provider will view the surgery as an elective procedure.

Requirements for Insurance Coverage

The patient should carefully review her medical insurance policy when considering a breast reduction surgery. If the insurance policy does not categorize this surgery as a covered procedure, then no insurance cover is possible under any circumstances. However, in several cases, reduction mammaplasty is not excluded from the list of covered procedures.

In such cases, the patient will have to submit a letter from the plastic surgeon explaining her health symptoms and physical findings, approximating the amount of the breast weight that will need to be decreased, and asking them to provide insurance coverage. Ideally, the patient should arrange this letter before scheduling the breast reduction procedure. The insurance provider may not be liable to pay if the surgery is not authorized beforehand.

Discuss with the Insurer

Insurance providers are usually updated on the present standards of treatment for macromastia. They should approve of the coverage as per the documentation of the health necessity as well as other reasonable conditions. But some insurers may still ignore the past 20 years of medical research literature highlighting the advantages of reduction mammaplasty in addressing the symptoms of macromastia, regardless of the woman’s overall weight.

If the insurer refuses coverage by stating that breast reduction surgery is an elective procedure, then the patient or the surgeon may try to inform them about symptomatic macromastia. The distinction between breast reduction and breast lift surgery may also have to be explained. Medical evidence of the patient’s continuous pain and unease should be provided to the insurer.

Once the insurer recognizes that ignoring the treatment for the painful condition of macromastia can lead to further complications, they may be amenable to offering insurance coverage for breast reduction surgery.

Appeal Process

The patient can legally appeal an insurance denial for breast reduction surgery. Various levels of appeal are typically available to the patient, and she may use these avenues. Letters from the family doctor, breast surgeon, chiropractor, physiotherapist, and massage therapist may be used in support of the appeal.
Perspicacious cosmetic surgeons at ACPS receive patients from Houston, Texas, TX, and other communities and neighborhoods in the outstanding Lone Star State for breast reduction.

For more information about The Aesthetic Center for Plastic Surgery (ACPS) physicians and the cosmetic surgery treatments and procedures they perform please click here or call us at 713.799.9999. We have offices in and around Houston, Texas.

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