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How would I go about getting my health insurance to pay for a breast reduction?

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Old 07-27-2009, 05:00 PM   #1
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Unhappy How would I go about getting my health insurance to pay for a breast reduction?

I'm 23, 5'7 and have size 38H breasts. (I can only get that size from Lane Bryant) I'm a little bit overweight but not obese. Ive been seeing a chiropractor (tho not too much in 2007-08 because i was finishing school) for years now and the main bone in my back that gives me problems is - you guessed it- the one right where my bra hooks in back. Ive actually layed on the floor with my digital scale and was able to put just one breast on it and it said 5 lbs. with the back pain and spine alignment issues, I also have stretch marks on my shoulders (from bras trying to work) and on my breasts. Normal clothes dont fit (obviously) and it's hard to do any kind of cardio workout without attempting to wear like 3 sport bras. Anyone think that's enough info? maybe a little tmi?.. lol
I really need this done.. My friend who actually had relatively smaller breasts than I got one and it helped her lose weight. Any exercise I do doesnt take weight off my breasts. Does anyone know how I could go about getting my insurance to pay for all or most of a reduction?

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Old 07-27-2009, 11:45 PM   #2
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Re: How would I go about getting my health insurance to pay for a breast reduction?

Insurance coverage for breast reduction is very dependent on the specific insurance plan under which you are covered. Every insurance company sells thousands of different policies, all with very different limitations and exclusions. The key to approval is that there must be medical necessity.

First get a copy of the exact plan under which you are covered and pay special attention to any area of the plan that talks about exclusions. Breast Reduction is very commonly noted as an exclusion. That means you may have an uphill battle on your hands.

Then see your primary care doctor and be prepared to discuss all of the physical symptoms and medical problems you are experiencing. Stay away from the non-medical necessity issues ("so my clothes fit better") and anything that can be construed as a mental health issue ("I'm depressed but this will make me feel better" will not play in your favor) Do stress, if it is applicable, that you find it increasingly difficult to maintain physical health due to inability to remain physically active, etc.

Seek out a qualified Plastic Surgeon via your primary care. Or, if your plan allows, do some of your own research to find a plastic surgeon who has extensive experience in this area of surgery.
Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

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