If you need breast reduction surgery, and wondering if your insurance will cover it, there are a few considerations you’ll need to go over. Of course all insurance companies are different in what they will and won’t cover, but there are typically a few common points you’ll need to consider before starting the filing process. Be prepared. Going through the process can be very frustrating. If at all possible, get your doctor’s recommendation for the surgery, emphasizing the medical necessity, being that most women seek breast reduction due to health concerns and general pain and discomfort.

Basically, there is a series of simple questions you’ll need to answer before you wade into the insurance process:

  1. Do you experience on-going pain and discomfort in at least two areas of your body such as?
  • Upper back
  • Shoulders
  • Neck
  1. Do you experience headaches?
  2. Have you begun to develop or have you experienced painful kyphosis evident in X-rays? [Kyphosis is the forward rounding of the back, i.e., curving of your spine]
  3. Painful indentations or cuts due to your bra straps?
  4. Have you had a mammogram within the last year?

Insurance companies will go to great lengths to avoid paying out to customers, and will first seek to get you to try more conservative approaches such as special, extra support bras with wider straps, or therapy such as with a chiropractor or other specialist. And, of course, they’ll hit you with the no-brainer questions like whether or not you’ve tried pain relievers like Ibuprofen, Acetaminophen, etc. REALLY???

The important thing is that your regular doctor should be able to help you greatly in making a case to push for coverage—at least in part—for your breast reduction surgery.

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