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Will Insurance Cover Breast Reduction Surgery?

Posted Dec 27, 2013 by Stephen Greenberg, MD

Manhattan Breast Reduction and InsuranceMany women are looking to obtain a more proportionate and attractive figure. However, for some women, the desire to change the body goes beyond an aesthetic goal. For women with overly large and disproportionate breasts, there is often a medical necessity to alter the size and shape of the breasts in order to alleviate pain and stress on the body. Plastic surgeon Stephen Greenberg performs breast reduction surgery to give patients a breast size that can be more comfortably supported by the body frame. Despite the desire to reduce the physical and emotional pain of disproportionately large breasts, it is natural that women in need of breast reduction surgery have concerns about covering the cost of the procedure. Fortunately, for many of our Manhattan patients undergoing breast reduction, insurance will cover the surgery in part or full because, in most instances, the surgery is a medical necessity.

When Is Coverage Available?

When determining whether insurance coverage is available for breast reduction surgery, it is extremely important to have early and frequent communication with the insurance provider. Before undergoing surgery, the patient should be in communication with the insurance company to determine what coverage is available and what information will be required in order to obtain coverage. For instance, most insurance providers will require a written report from the plastic surgeon detailing the physical symptoms that have been experienced, as well as how surgery can help. Additionally, most insurance providers require photos of the breasts as further documentation. Common physical ailments that may qualify as a medical necessity for breast reduction surgery include:

  • Back pain
  • Neck pain
  • Shoulder pain
  • Skin irritation (commonly beneath the folds of the breast)
  • Physical limitations due to breast size
  • Damage of the skeletal frame due to disproportionately large breasts

It is important to be honest with Dr. Greenberg during your surgical consultation regarding any physical and emotional discomfort that has been felt so that any symptoms that have been experienced can be properly documented for the insurance provider.

If it is determined that insurance will be available to cover breast reduction surgery, it is also important to establish exactly what costs will be covered. The cost of breast reduction surgery may include fees for the surgeon, the hospital, anesthesiologist, lab fees, and more. It is important to know beforehand if there will be any out-of-pocket costs for fees that have not been covered by the insurance provider.  Our staff is happy to work with a patient’s insurance provider in order to help determine the specific coverage for which each patient will qualify. Once surgery has taken place, we want our patients to be free to focus on resting and recovery, so it is best to have any insurance issues sorted out before surgery.

Schedule a Consultation

No patient should have to endure the physical or emotional discomfort that can result from breasts that are large and disproportionate. If you have suffered as a result of breast size and would like to learn more about breast reduction surgery, schedule a consultation with Dr. Stephen Greenberg at your earliest convenience. We look forward to meeting you!

Greenberg Cosmetic Surgery
Manhattan Office
461 Park Ave S
Manhattan, NY 10016
(212) 319-4999

Woodbury Office
160 Crossways Park Dr
Woodbury, NY 11797
(516) 364-4200

Southampton Office
365 County Rd 39A  Ste 7
Southampton, NY 11968
(631) 287-4999

Boca Raton Office
1599 NW 9th Avenue
Boca Raton, FL 33486
(561) 208-1080