Will my health insurance cover my breast reduction?

• Symptoms – Your plastic surgeon will create your consultation record to submit to your insurance carrier.

• Conservative therapy – be prepared to gather all of the previous physician, chiropractor, and physical therapists records that support your case.   These generally include weight loss, postural training, back therapy, anti-inflammatories and more.  The duration of treatment is important, some requiring 6 months.

• Most insurance companies will look at your BMI (roughly whether you are overweight for your height).  They may deny if you are overweight.

• Amount of breast tissue to be removed.  The previous cut-off was 500 grams (just over a pound) of breast tissue to be removed.  Some Utah health insurance companies have increased this requirement to 600 grams (including Blue Cross and Altius) and some base the weight that must be removed on the BMI.  There is little true science to support these weights, the cut-off is arbitrary

• Photos – Your plastic surgeon may submit photos for authorization.

• Blue Cross federal and Medicare won’t give an authorization for surgery.  Your surgeon will make sure that all of the criteria have been met.
• Molina Medicaid does not consider this a covered benefit.
• PEHP does not require an authorization but the patient is responsible for 1/2 of the charges.