Is Breast Reduction Surgery Covered by Insurance?
Miami plastic surgeon Sean Simon, MD says, “Breast reduction surgery was more commonly covered by insurance in the past, but may still be covered if certain conditions are met. The patient’s consultation should document specific issues associated with macromastia, or very enlarged breasts. These are heavy, pendulous breasts that are often associated with back, shoulder and neck discomfort. They can also cause difficulty with certain physical activities and clothing fitting properly.”
What to Ask Your Insurance About Coverage for Breast Surgery
Dr. Simon says patients should reach out to their insurance carrier first to see if coverage is even possible before consulting with a surgeon. “For a breast reduction, I always advise patients to speak with the customer support or patient advocate rep from their insurance company prior to scheduling surgery.” That way no one gets their hopes up only to find out that they have to pay out of pocket.
Breast Reconstruction Surgery: What Insurance Covers
According to information published in The Breast Reconstruction Guidebook, which is also provided on Breastcancer.org, breast reconstruction procedures should be covered by your health insurance plan, whether they are done right away, soon after mastectomy/lumpectomy, or many years later. This includes procedures that may be needed over time to refine the reconstruction and/or to create symmetry between the breasts.” Dr. Simon says these can include nipple reconstruction as well.