Can You Attain Insurance Coverage for Breast Reduction?

Can You Attain Insurance Coverage for Breast Reduction?

Breast Reduction Insurance Coverage | Dallas Plastic SurgeryInsurance Coverage for Breast Reduction

Breast reduction plastic surgery in Dallas and other areas may or may not be covered by insurance. Each health insurance company may have slightly different policies with regard to such procedures. If the insurance provider is convinced that breast reduction is medically necessary for a particular policy holder, the cost of the procedure may be covered. It may also be important to determine what parts of the total cost will be covered by the insurance provider, if at all there is coverage for breast reduction surgery. Typical cost components of breast reduction are as follows:

  • Cost of the surgical facility or hospital
  • Cost of anesthesia
  • Surgeon’s fee
  • Cost of medical tests
  • Cost of prescribed medications
  • Cost of post-surgical garments

If the insurance health provider considers breast reduction procedure as a reconstructive surgery, the complete cost of the procedure may be covered. However, the patient should be able to show that the surgery is necessary to provide relief from medical symptoms. A number of medical insurance companies will accept breast reduction as a reconstructive procedure depending on the degree of breast tissue that will be removed.

This is the clearest indicator for an insurance provider to assess how seriously the patient needs to undergo breast reduction for medical reasons. Pre-certification is usually necessary in any case for breast reduction coverage or reimbursement. Patients who are dependent on insurance for this procedure must go ahead with the surgery only after they have cleared the formalities with their insurance provider, in coordination with their cosmetic surgeon in Dallas or elsewhere.

How to Determine Your Coverage Status?

Rather than rely on presumptions or information provided by third parties, it is always a good idea to contact the insurance provider directly before going ahead with breast reduction. The patient should ask about all the specific terms and conditions with regard to coverage for breast reduction procedure. The insurance company representative or agent will provide clear guidelines that need to be met in order to get coverage for this surgery.

In most cases, the insurance provider may ask for some kind of letter or certification from a doctor that attests that the patient suffers from specific physical discomfort or pain as a result of excessive breast size. The insurance company may also ask for a letter in advance from the plastic surgeon, which provides the surgeon’s evaluation regarding how much breast tissue may have to be removed.

Contacting the Insurance Provider

Insurance coverage requirements are likely to vary from one insurer to another and also from one state to another. Therefore, it is advisable to receive this information directly from the insurance provider, and then make a decision pertaining to this surgery. The office of the doctor or the plastic surgeon involved may also provide guidance and assistance with regard to completion of insurance requirements and formalities.

The insurance provider may cover breast reduction surgery up to a certain limit of expenditure. With some effort, even if partial coverage of surgical costs is achieved, it can prove to be a big support for a patient. Financing options may also be available from the surgeon’s office or through third parties to make it more financially convenient for the patient to undergo breast reduction.


For more information on plastic surgery procedures and treatments performed by Plastic Surgeon, Bradley A. Hubbard MD in Dallas, Plano, Frisco and surrounding areas schedule a consultation by clicking here or calling 214-370-4813

2018-04-26T20:19:45+00:00October 22nd, 2013|Breast Augmentation, Cosmetic Surgery, Plastic Surgery|
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