Does Health Insurance Cover Breast Reduction Surgery?

Does Health Insurance Cover Breast

The health risks associated with macromastia, or abnormally huge breasts, are not temporary. The Aesthetic Society reports that in 2021 there were over 80,000 breast reductions performed in the United States, a 49% increase over the previous year. Reduction mammoplasty (breast reduction) is often seen as a cosmetic and elective operation by insurance providers.

However, there are circumstances in which this surgery becomes a need from a healthcare standpoint. Costs associated with this procedure are often covered by health insurance policies if the patient meets certain criteria.

The medical need for breast reduction

The procedure must be deemed medically essential by a licensed doctor. The medical professional examining you should also make sure that you have exhausted all other options for dealing with the long-term health issues associated with macromastia before considering surgery. Insurance companies should pay for a reduction mammoplasty if it is necessary to treat:

Steps to take to guarantee breast reduction coverage from your insurance company

Getting breast reduction surgery insurance coverage requires completing a number of hoops. In order to establish that the operation is a medical necessity, you will need to spend some time dealing with paperwork and providers. If you want to know if your health insurance will cover this procedure and if this sort of surgery is right for your situation, here’s what you need to do:

Get a doctor’s note stating that your breast size is a symptom of a medical issue that affects your everyday physical and emotional well-being (for example back pain due to large breasts or breathing). When submitting a claim to your insurer, you’ll need to have this paperwork on hand.

Find out what level of proof is required before they will pay for the procedure; this might mean undergoing a number of therapies (such as weight loss/gain) before they agree that breast reduction surgery is an acceptable and necessary therapy.

Before approaching your insurance company regarding breast reduction surgery, you should do your research and become familiar with the specifics of your policy. Talk to a helpful licensed agent at Healthily immediately to get the best plan and learn whether or not your current policy will cover your upcoming operation. For further details, please contact us at 855-522-2201.