Insurance Requirements for Breast Reduction By Stuart Baker on January 13, 2020

A woman in a grey braIf you have breasts that are too large, they can have a negative impact on your appearance and your overall sense of well being. Breasts that are too large can cause body pains, sore or tender skin, and a host of other health issues. That’s when getting a breast reduction may be a good idea. Dr. Stuart Baker has performed reduction mammaplasty on numerous women in the greater Monticello, IL area who have excessively large breasts.

The team at the Center for Cosmetic Medicine often reminds breast reduction patients that their procedure may be covered by medical insurance if certain criteria is in place. Let’s discuss insurance coverage for breast reduction and what that involves.

Abnormally Large Breasts and Macromastia

The word “macromastia” is the medical term for abnormally large breasts. If a patient is diagnosed with macromastia, they can undergo breast reduction to treat the condition and potentially have the surgery covered by their insurance.

Is Breast Reduction Covered by Medical Insurance?

Yes, though certain conditions need to be met.

In many cases, breast enhancement surgeries are considered elective procedures, breast reduction included. In order to qualify for health insurance covers, patients must demonstrate that a breast reduction is a medical necessity. That generally means that a woman’s health is negatively affected because of the excessive size of her breasts.

Common Requirements to Receive Insurance Coverage

In order for insurance companies to seriously consider covering a breast reduction procedure, patients must demonstrate a link between the excessive size of their breasts and the following conditions:

  • Back pain
  • Neck pain
  • Shoulder pain
  • Skin damage from bra straps
  • Headaches

In addition to the above, the patient’s health issues related to macromastia must be documented by a physician or specialist. Up to a year’s worth of medical visits and documentation may be required in order to receive consideration for insurance coverage.

Finally, the insurance provider may need a treatment plan from a plastic surgeon, detailing the health issues a patient faces and how much breast tissue will be removed during the procedure.

Check with Your Insurance Provider for More Details

Since insurance providers and their terms can vary, it’s important that you check with your insurance provider first. They can let you know what documentation is required and from whom. By learning what is needed to receive insurance coverage, you can then plan medical visits and plastic surgery visits as needed.

It pays to do your research and be prepared, especially when you face legitimate health issues because of the size of your breasts.

How Our Team Can Help with This Process

Our Monticello plastic surgery center can work with general practitioners and patients to develop the necessary paperwork and documentation for the breast reduction surgery.

If you run into any roadblocks or hurdles when it comes to insurance coverage, we can offer insight that helps you get the surgery you need. This professional knowledge of what other patients have gone through can help you avoid delays in coverage and further issues that prevent you from getting a breast reduction.

Learn More About Breast Reduction Surgery

If you want to learn more about breast reduction and how it can benefit you, be sure to contact a skilled plastic surgeon. The Center for Cosmetic Medicine can be reached by phone in Monticello at (217) 877-9439, in Champaign at (217) 378-8000, and in Decatur at (217) 877-9000.

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Dr. Stuart Baker

The Center for Cosmetic Medicine

Dr. Stuart Baker is a board-certified plastic surgeon with decades of experience. He has been recognized as a "master injector" by Allergan, the maker of BOTOX® Cosmetic and JUVÉDERM® products, for excellent patient outcomes. In addition to being a skilled plastic surgeon, he is also an orthopedic hand surgery specialist. His prestigious affiliations include:

  • American Society of Plastic Surgeons — ASPS 
  • American Society for Aesthetic Plastic Surgery — ASAPS 
  • American Academy of Cosmetic Surgery — AACS 
  • American Medical Association — AMA 

Use our online form to schedule a consultation at a location near you in Monticello, Champaign, or Decatur. Or call us at:

(217) 877-9000

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