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Will My Insurance Provider Cover the Cost of My Breast Reduction Surgery?

Generally speaking, breast reduction surgery is often classified as a cosmetic procedure. And, unfortunately, most cosmetic procedures are not covered by health insurance providers.  However, there are some exceptions to the rule.  With a lot of preparation and patience, you just may be able to get your insurance provider to foot the bill on your downsized breasts. 

Mammaplasty is the common surgical procedure of removing excess skin, tissue, and fat from the breasts, reducing the overall size and density of a woman’s breasts.  There are many personal reasons a woman may wish to reduce the size of her breasts, such as chronic pain and discomfort in the neck, shoulders, and upper back due to oversized, heavy breasts, bra straps digging into flesh leaving unsightly marks, and recurring skin infections/tags beneath the folds of the breasts.  Besides the mitigation of pain, there may be aesthetic reasons at play, as well, such as achieving a more proportioned breast-to-hip ratio or flaunting a proportionate figure overall.  Some women feel they would gain more confidence if their cup size was equivalent to their pants size.  Basically, women seeking mammaplasty simply desire a more functional breast size and aesthetically appealing appearance.   

A Real Pain in the Neck:  Getting Your Health Insurance to Cover the Costs of  Your Breast Reduction Surgery

While the approval process differs case by case and company by company, there is one thing that remains constant – doing your homework and collecting a lot of paperwork.  It’s important to start doing the legwork and getting all your ducks in a row at least 3-6 months prior to your impending surgery.  Beverly Hills Breast Institute has  savvy insurance specialists on staff to help you navigate the murky waters of the health insurance industry as it relates to cosmetic surgery.  But, expect to furnish your insurance provider with a letter recommending mammaplasty a medical necessity, clearly stating that the surgical procedure is the “last ditch effort” required to resolve an underlying health-related issue.  Be prepared to furnish up to 12 months of convincing documentation that thoroughly lists all treatments performed by medical professionals, such as physical therapists, chiropractors, dermatologists, orthopedists, etc., to support your case for a mammaplasty.  Unless your insurance provider is sold on the recommendation of the procedure to rectify a health-related issue, you will have to cover the costs personally, which can be costly.  So, it’s in your best interest to provide your provider with everything they need to solidify your claim.  

We understand it can be a painstaking process and we’re here to help make it as painless as possible, but you can significantly expedite the process by contacting your insurance provider about initial steps needed.  Again, be prepared to talk with them months before your impending surgery.  Once all compulsory material and documentation is collected and submitted, the average turnaround time can take anywhere from 3-6 additional months.  During this time, your provider will be consulting with your physician and seeking second opinions to confirm if surgery is absolutely necessary to rectify your medical matter.  Keep in mind, if insurance companies can get out of paying for any procedure, they certainly will find a plausible way.  So, it’s important to give them every reason why they MUST pay.  

Worst Case Scenario

If you find your insurance company rejected your claim for mammaplasty, all is not lost.  We offer an array of customized payment plans and financing options to fit every budget and will be more than happy to discuss such solutions prior to your surgery.


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