- Health insurance typically covers breast reduction surgery that is deemed medically required but does not typically cover aesthetic breast reduction.
- Different standards are routinely used by health insurance companies to determine whether breast reduction surgery is medically necessary.
- You’ll likely need proof of ongoing health problems caused by your large breasts in order to obtain insurance coverage.
Very huge breasts, often known as macromastia, might have negative health effects. Back, shoulder, and neck pain could result from the weight of the breasts. Some women develop persistent sores under the breasts or permanent shoulder grooves from bra straps.
Breast reduction surgery, also known as reduction mammoplasty, has psychological advantages in addition to treating physical issues like these. It can raise people’s quality of life, sense of self, and perceptions of their bodies.
If you’re thinking about having your breasts reduced, you probably want to know how much surgery will cost and whether your insurance would cover it. Cosmetic breast reduction surgery is not covered under insurance. However, if you need the procedure for a medical condition, your health insurance may pay for it. The requirements for obtaining coverage for a breast reduction vary depending on your insurer.
Continue reading for more information on breast reduction surgery costs and when insurance will cover them.
Mammaplasty, often known as breast reduction surgery, is a surgical treatment in which a cosmetic surgeon removes extra skin, fat, and tissue in order to lower a patient’s total breast size. Breast reduction surgery is beneficial for those who have enormous breasts since it can reduce discomfort while also achieving breast size that is proportionate to the rest of the body.
In addition to improving a woman’s physical condition, mammoplasty can also boost her confidence. In this post, we’ll look more closely at what this surgery requires and how to get health insurance to pay for it.
What to Expect During Surgery
Breast reduction surgery is nearly always carried out under general anesthesia in a hospital or outpatient setting, as you might anticipate. The physician will either make a surgical incision or perform liposuction during the surgery to remove extra fat and shrink the patient’s breasts overall.
Before removing fat, tissue, and skin, which in turn reduces the size of the breast overall, the surgeon will also make an incision down the length of each breast and around the areola, which is the pigmented ring enclosing the nipple. Before the areola is once again positioned on the newly enlarged breast, the breasts are lastly reshaped.
Finally, the areola is moved to fit the increased size of the breasts and the breasts are contoured.
Who Should Consider Breast Reduction Surgery
Although most women choose to get mammoplasty to relieve discomfort and to achieve more proportionate breast size, there are various other causes, such :
- Nerve pain
- inadequately sized bras and other clothing
- a restriction on participating in certain activities
- rashes on the skin beneath the breasts
- back, shoulder, and neck pain
Is Breast Reduction Surgery Safe?
Despite the inherent danger of all surgical operations, mammoplasty is typically risk-free, with the majority of difficulties coming from an unfavourable anaesthetic reaction, bleeding, and infections at the incision site.
However, not all women with huge breasts will benefit from breast reduction surgery. For instance, young ladies under the age of 16 are advised against having the surgery done because their breasts are typically still developing. The following additional elements can disqualify breast reduction surgery:
- refusing to have scars on your breasts
Is breast reduction covered by health insurance?
It varies. Breast reduction is only covered by health insurance if it is deemed medically required to treat persistent health issues.
This implies that you’ll likely need to obtain insurance authorization before scheduling the breast reduction surgery. The insurance provider will ask your surgeon to submit certain medical information on your behalf, after which it will determine if you actually need the procedure. (You’ll still have to pay copays or deductibles even if your insurance does cover the surgery.)
The insurance provider won’t pay for breast reduction surgery if it doesn’t match the medical necessity requirements of your health plan because it will be viewed as cosmetic.
The price of breast reduction surgery may be a deciding issue for you. In order to reduce the size of the breast, the operation removes skin, glandular tissue, and fat from it. Treatment of health issues brought on by excessively big breasts for women may be medically required. The operation is mostly cosmetic for males who have larger breasts; you may want it, but you are not medically required to have it. Insurance companies often pay for surgeries that are medically required but not aesthetic.
What determines the cost of breast reduction?
The price of breast reduction varies based on where you reside, like most goods and services do. Additionally, prices differ amongst surgeons. Generally speaking, cosmetic or plastic surgeons can set their fees based on local consumer demand—whatever they are prepared to spend. The amount a surgeon charges may also be influenced by their level of training, experience, and technique skill.
Prior to having breast reduction surgery, inquire about costs.
Make sure you completely grasp your financial responsibility before deciding on breast reduction surgery. Verify the responses to the following questions to see if your insurance will pay for your breast reduction:
- Do I need to visit a surgeon who is a part of the network to be fully covered for my procedure?
- What copayments and deductibles are my responsibility?
- What kind of coverage do I have if I require a second operation to address a surgical complication?
- Additionally, confirm that your surgeon will honor the agreed-upon surgical cost with the business and accept your insurance. Make sure you don’t have to pay any difference between the surgeon’s fee and the insurance company’s reimbursement, to put it another way.
Start by asking your surgeon the following questions if you are paying for your own breast reduction:
- Can you give me written information on all of my expenses, not only the price of the procedure?
- Do the costs include my aftercare?
- Will I be paid if I require additional surgery, whether it be to address a complication or to undergo revision surgery if I am unhappy with the way my breasts look overall?
- Do you provide a payment schedule?
- Hospital or surgery centre charges for anaesthesia
- tests that you might need before surgery
- medication and post-surgery clothing modifications
- The price of breast reduction may be covered by insurance.
For women who experience health issues as a result of the size of their breasts, insurance typically pays for breast reduction. For instance, having too large breasts can interfere with your daily activities by causing back, neck, and shoulder pain. Preauthorization for the surgery may be required by your insurance provider. They’ll probably need proof of your medical issues as part of the process.
You might also need to try out other therapies first, according to your insurance provider. Weight loss, physical therapy, and wearing wide-strapped bras for at least a year may all be part of this. Each organisation will use its own standards to approve breast reduction surgery. To review the details of your policy, you must call your insurance provider.
You may appeal the decision if your insurance provider rejects your request for surgery authorization. For the appeal, you will want the cooperation of your physician. It might only require that you provide further details about your problem.
Gynecomastia surgery, often known as male breast reduction surgery, is typically not covered by insurance.
Does Health Insurance Cover Breast Reconstruction?
There are exceptions to the rule, but in general, insurance will only pay for breast reconstruction surgery if it is judged medically essential. Unless the patient can demonstrate that they have an underlying health condition that can only be remedied by undergoing the corrective operation, breast reduction surgery will typically be considered a cosmetic procedure.
Unless the patient can demonstrate that they have an underlying health condition that can only be remedied by undergoing the corrective operation, breast reduction surgery will typically be considered a cosmetic procedure. Additionally, before the procedure is covered by an insurance coverage, individuals must reach a set insurance level.