Does Insurance Cover Breast Reduction?

By Dr. Jim Greene

Unlike a breast augmentation procedure, many insurance companies will in fact cover a breast reduction procedure. The reasons that an insurance company will or will not cover the procedure comes down to a couple of related factors. For starters what you have to keep in mind is that in general the procedure is a medical necessity. What this means is that the breast, if they are too large causes a variety of back and neck pains as well as they have been known to reduce the physical activity of the person. By undergoing the procedure you are able to get rid of or prevent the pains from occurring. Furthermore the procedure generally leads to an increased physical activity which also increases a person's overall medical health.

In some cases though, the insurance companies will not cover the breast reduction if it can be considered a cosmetic need. In other words if your breasts are only a cup or two over normal size and you are still able to stay physically active and there is no pain then they will most likely not cover the procedure. Furthermore if you are overweight and your breasts are oversized for this reason, then chances are they will not cover the breast reduction procedure and since one of the major requirements is that you are in fact healthy.

The insurance companies may also ask for a photograph proving that your breasts are too large. This is not some type of scheme just to get a topless photo of you but rather it can be a detrimental part of the decision making process. You may also need a letter of medical necessity from you doctor stating that the size of the breasts are in fact inhibiting your ability to stay physically active and healthy.

Your family physician is an integral part of the breast reduction procedure so make sure that he or she is included if not for the simple fact that the insurance companies will listen to the doctor long before they will even acknowledge you.