Will Insurance Cover Breast Reduction?
Considering breast reduction surgery? Not sure if your insurance covers breast reduction or whether you are eligible? Can't seem to find any one who knows the answer to your questions? We're here to help. At the Breast Reduction Center Los Angeles, we are asked these and other question every day by patients who just want to understand what their options are and what they are entitled to as a health insurance policy holders.
What are the general Breast Reduction insurance requirements?
Some insurance carriers contribute to breast reduction as long as it meets their requirements to be deemed "medically necessary". Traditionally the main point an insurance company considers is the amount of tissue to be removed from each breast. Most major insurance companies have established basic criteria as to the amount of tissue that must be removed relative to a patient's height and weight. Insurance companies are beginning to focus more on patient's symptoms to determine whether breast reduction is medically necessary. Health concerns such as back and neck pain, or skin rash developing in the skin underneath one's breasts is sometimes sufficient to qualify a patient for some insurance coverage for breast reduction. Typically any procedure in which the breasts are reduced by less than two cup sizes is categorized as a breast lift and will not be covered by insurance.
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"Everyone at the Breast Reduction Center is so nice and helpful. They helped me navigate and understand my breast reduction insurance coverage, and I was actually able to get my entire breast reduction surgery done with very little out of pocket expense. This place is just wonderful!" - J. F.
How do I find out my insurance provider's terms regarding Breast Reduction?
Most major insurance companies provide insurance coverage for breast reduction, but there are several factors that must be looked at in order to determine whether you are eligible for coverage.
Your insurance company must first determine whether they consider your breast reduction medically necessary. The terms and guidelines used to determine this may vary depending on your insurance company, the state you live in and your specific policy. It can be a little a confusing, but don't worry. You don't have to figure it all out on your own. Our friendly and knowledgeable staff can help you to quickly determine what your insurance will cover and whether you meet the requirements. Call us for a free insurance verification today or simply fill out the form below to get started.
How breast reduction insurance coverage is determined:
When you come in to the Breast Reduction Center for your initial consultation, the breast reduction surgeon will conduct a thorough examination of your situation. During this consult your surgeon will determine how many grams of tissue need to be removed to make your breasts proportional to your body and alleviate any health concerns. Once this has been determined, your surgeon will submit this information to you insurance company for approval.
Most insurance companies use a simple, standard calculation which to determine your body surface area or BSA. Height and weight is all that is needed to calculate your BSA. Once you BSA has been established, it is compared to something called the Schnur Sliding Scale.
The Schnur Scale was developed by a plastic surgeon and is used as a method of evaluating the medical necessity of a breast reduction. Your insurance company will use the scale to compare your body surface area to the amount of tissue your surgeon has recommended for removal and determine if you truly need a breast reduction for medical reasons.
Again the amount breast tissue to be removed is not the only criteria used by insurance companies to qualify patients for breast reduction surgery, but it is an important factor in the insurance eligibility process.
