Is Breast Lift and Breast Reduction Covered by Insurance?

July 18, 2023 | By admin

If a woman has excessively large breasts, then it is a condition that is known as macromastia and it can cause several health problems. The weight of the breasts may lead to pain in the back, shoulder, and neck. Some women might also get permanent shoulder grooves by bra straps or recurrent rashes under the breasts.

Breast reduction and lift is a surgical procedure that can help a woman decrease the size of her breasts and lift the breasts to achieve a perkier appearance. It can improve a patient’s quality of life, self-esteem, and body image.

And if you are considering getting a breast reduction or breast lift, you must also be wondering about the total cost of the procedure. Another question that you might be asking is: can I cover insurance for breast reduction or lift?

This is a common and important question that a lot of patients have to see and evaluate their payment options for a breast reduction or breast lift. The short answer to the breast reduction insurance question is that it may be covered under insurance if one is getting this surgery for medical reasons. Keep reading to find out more.

 

Is Breast Reduction Covered By Health Insurance?

The long answer to this question is that it depends. Health insurance only covers medical procedures that are necessary due to health reasons. This is why if a breast reduction or lift is deemed medically necessary for the health of a patient, then it might be covered under health insurance. However, to know the exact answer, one must reach out to his or her medical insurance provider.

In some cases, it is also possible that even if the surgery is covered under insurance, the patient might still have to pay copays or deductibles. The surgery will not be covered if it is done for purely aesthetic reasons.

How To Get A Breast Reduction Covered By Insurance?

Getting approval for a breast reduction or lift surgery can be a long, complicated process. This is because insurers have different criteria for judging the surgery as medically necessary. However, to start the process, the insurer will need:

  • A physician’s letter detailing the health symptoms and how long the patient has had them
  • Medical records of previous treatments
  • Height and weight of the patient
  • Photos of the breasts
  • Record of the patient that shows chronic health symptoms caused due to heavy breasts
  • Record showing that the patient has tried other treatments and how those treatments have not helped

Some insurers may also require the patients to be within 20% of their ideal body weight before approving the coverage as weight loss alone can cause the breasts to become smaller in some cases. Because of these reasons, the best bet is for the individual to contact the insurer as soon as possible and get the doubts solved.

  

What Makes A Breast Reduction Or Lift Medically Necessary?

A doctor will determine if a breast reduction or lift is medically necessary for a patient or not. For that to happen, the patient must provide evidence to the doctor and insurer of trying out other methods of seeking relief from medical symptoms like physical therapy, and musculoskeletal treatments.

The insurance company might also ask for proof that the patient has suffered from the symptoms for at least 6 months. Some insurance companies may approve a breast reduction or lift if the patient has the following symptoms:

  • Severe rashes or skin infections that are hard to treat
  • The physical activities of the patient are restricted
  • Nerve compression due to the weight of the breasts
  • The posture and spine alignment is affected due to the breasts
  • The breasts are painful
  • There is upper, back, neck, or shoulder pain

Do Breasts Have To Be A Certain Size For Approved Breast Reduction?

When it comes to breast reduction or lift surgery, it is not only a matter of how large the breasts are. Instead, the concern is the amount of tissue to be removed and the symptoms experienced by the patient due to the large breasts.

Some insurance providers use the Schnur Sliding Scale as a reference. This scale provides a ratio that compares the weight of the removed breast tissue with the total body surface area. This is just a common guideline and not an absolute rule.

Usually, if the Schnur ratio is above the 22nd percentile, the surgery is considered medically necessary. If it’s below the 5th percentile, it’s considered cosmetic. If the ratio is somewhere in between, it may be considered either medical or cosmetic depending on the guidelines set by the insurer.

Have More Questions? The Experts At Divine Cosmetic Surgery Can Help

Do you have more questions about if a breast reduction or lift is covered by your medical insurance? Do you want help figuring out the answers to these questions? If yes, then you should seek the help of the medical experts at Divine Cosmetic Surgery.

The medical team at Divine Cosmetic Surgery has a collective experience of decades in providing patients with amazing breast reduction and lift results. The team goes above and beyond to make sure that patients always receive the best results.

So, what are you waiting for? Book your first consultation or directly reach out to our medical experts to get the answers to all your questions!

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