Will Insurance Cover a Breast Reduction?
- Posted on: Jan 28 2014
For some patients, breast reduction surgery is a purely cosmetic procedure that allows patients to meet their aesthetic goals. However, in a large number of cases, breast reduction is performed in order to eliminate physical pain and reduce physical limitations that have resulted from overly large breasts that are disproportionate to a patient’s body frame. At Dr. Christopher J. Kovanda’s plastic surgery practice, he is happy to perform breast reduction surgery to relieve the physical and emotional stress that is experienced by the majority of patients with dense, heavy breasts. Because many of our Minneapolis patients qualify for breast reduction insurance coverage, our staff works closely with patients’ providers to determine what documentation is required to obtain available coverage.
Do I Qualify for Insurance Coverage?
For patients who are considering a breast reduction, it is important to examine insurance coverage material before scheduling surgery. If the policy specifically excludes breast reduction surgery than none of the fees associated will be covered and the patient will be responsible for all surgical costs. Patients who do have policies that offer coverage for breast reduction surgery will likely need to receive approval prior to the surgical procedure. This eliminates the risk of the patient being denied coverage and being responsible for the surgical costs after the procedure has already been performed. When coverage is offered, it is in cases of medical necessity. The following symptoms are often signs that breast reduction surgery will be medically beneficial:
- The patient is experiencing pain in the neck, shoulders, or back as the result of large breasts
- The patient has suffered from skin rashes or irritation in the folds of skin beneath the breasts
- The patient’s posture has suffered under the weight of the breasts
- The patient has physical limitations due to the size or weight of the breasts
- The patient’s body frame is disproportionate in size to the breasts
For patients with these symptoms, Dr. Kovanda can likely make a medical recommendation for breast reduction surgery. Most insurance companies will require written details from Dr. Kovanda documenting the patient’s physical symptoms as well as a surgical plan for how much breast tissue will be removed. This material will be examined by insurance providers so that they can make their decision on whether coverage will be approved.
How Much Coverage Will I Get?
Even for patients who do qualify for insurance coverage, the amount of coverage that is available will vary by the patient’s insurance plan. It is unlikely that the procedure will be covered in full. Our staff can work alongside your insurance provider in order to determine how much coverage will be provided and how much patients can expect for out-of-pocket costs. Any expenses that the patient will be responsible for (including the costs for patients without insurance coverage) can likely be made more affordable through alternate financing options. Our staff is happy to discuss these options with our patients.
Schedule an Appointment
No patient should have to suffer the emotional or physical pain of overly large breasts. If you are interested in learning how breast reduction surgery can free you of the physical and emotional limitations of heavy breasts, schedule an appointment with Dr. Christopher J. Kovanda at your earliest convenience. We look forward to meeting you!
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