Will Insurance Cover Breast Reduction?

Breast reduction is an extremely effective treatment for back pain in women. The weight and anterior displacement of large, droopy breasts leads to poor posture. This results in pain of the upper back, shoulders, and neck. Sometimes this will contribute to headache or numbness or tingling in the arms or hands. Frequently the contact of skin beneath the breasts leads to rash or skin breakdown.

Dr. Sam Bryant pictured on right.

Breast reduction reduces the weight of the breasts, and the remaining tissue is lifted and lies closer to the center of gravity. Posture is improved and the patients experience relief of their pain symptoms immediately. The success of this procedure has made it a very common procedure performed at Bryant Cosmetic Surgery.

Because of our familiarity with this procedure, we are experienced with obtaining insurance coverage for qualified patients. The question then, is what determines a qualified patient? This determination has recently become much more difficult to obtain. Generally, we know that a patient will have to exhibit symptoms of pain to their back, neck, or shoulders. There should be evidence of grooves on the shoulders from their bra straps.  There could be a history of rash or skin breakdown beneath the breasts.

The difficulty comes when evaluating the history of treatment for the pain. Some insurance companies are requiring that the patient has had a physician guided weight loss program, if the patient is overweight. Some require proof that the patient underwent a full trial of physical therapy or chiropractic manipulation. Most companies now require primary physician records documenting the problem and the treatment attempts over a period of time. Since this is rarely the reason the patient is being seen by a physician, this notation is often minimal or absent. 

Our office works diligently to try and obtain surgery pre-determination for the patients we see. We contact primary physician offices when necessary for copies of notes, if needed. We will continue to do our best, but unfortunately the current insurance climate is making it difficult or impossible in many cases. Primary physician identification of symptom producing breast hypertrophy, and documentation of treatment can make a real difference in whether a patient will be covered for the procedure.

Fortunately, not all insurance companies cause delays.  Blue Cross Blue Shield of Nebraska allows us to do our own pre-determination based on published factors we can readily assess. Other companies make it almost impossible to get approval. We are always willing to try our best to help the patient.