Substantially reducing the size of the breasts with surgery is considered by most plastic surgeons and patients to be reconstructive in nature and not cosmetic. Unfortunately, many insurance companies do not quite see it that way and can make it difficult to obtain authorization for a breast reduction (reduction mammoplasty). The trend by more insurance companies over the last several years has been to exclude this surgery as a potential covered benefit. In order to determine whether you may be eligible for coverage, you will need to contact your insurance company and provide them with your specific policy number.
Even if benefits are available, there is no guarantee that you will be approved for the breast reduction. Most insurance companies require documentation of your symptoms related to your enlarged breasts (mammary hypertrophy or gigantomastia) as well as supportive photos. These issues can include neck, back and shoulder pains, grooving of the shoulders from the bra straps, postural changes, headaches, rashes and skin breakdown, and even numbness of the arms. Some companies have established very stringent criteria that can include height and weight numbers, body mass index (BMI), evidence of a prolonged course of physical therapy that did not alleviate symptoms, and several letters from various medical personnel including your primary care physician. Most also require that the anticipated weight of breast tissue to be removed per side exceeds a specific amount.
In the worse cases scenario, if your policy does not provide benefits for a breast reduction or you have been refused authorization for surgery, the procedure can still be performed though you would be responsible for the attendant costs. The results from the surgery are so effective and rewarding, that many of my patients who cannot get insurance coverage will pay to have the procedure done in order to obtain relief from their symptoms.
At the Arizona Center for Aesthetic Plastic Surgery, we offer several ways for you to keep costs down and make the surgery more affordable. Package pricing is available that can save you thousands of dollars off typical hospital costs. We also accept various credit cards and offer financing from several companies that will allow you to make more affordable payments spread out over time. You can call our office at 480-451-3000 for further information and assistance regarding breast reduction, insurance questions, financing, and scheduling your consultation.
Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix, Arizona