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How do I get my insurance company (PPO) to cover my breast reduction surgery?

Q:

Is there a way around getting my breast reduction surgery covered if my insurance company has stated that they do not cover such?  It is not for cosmetic reasons as I have shoulder grooving, irritation underneath my breasts, excessive sweating underneath, etc.  What is the criteria needed to be met for insurance coverage for this procedure?

A:

This is your insurance policy. So, you will need to contact your insurance carrier to ask for their criteria for pre approval of Breast Reductions. Unfortunately, insurance carriers dictate health care coverage, not physicians. Insurance policy costs often vary based upon the amount of coverage, your age, etc.

One option, if your insurance carrier does not cover Breast Reduction, is to ask your employer if you can switch to a different carrier that does. If this is not an option, consider having the procedure done as a Cosmetic procedure. Many ASAPS Surgeons offer package pricing for these types of procedures, which would be less than a hospital bill for the same procedure (Breast Reduction Package).

Best,

Gary R. Culbertson, MD, FACS

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