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Is breast reduction a cosmetic surgery procedure or a necessity?

Dr. Matt Bindewald, plastic surgeon in San Antonio, discusses insurance coverage of breast reduction

· Breast Reduction,Psychological Impact,Insurance Coverage

Does Insurance Cover Breast Reduction Surgery?

Breast reduction surgery is a common procedure. Approximately 114,000 women in the United States underwent breast reduction surgery in 2014 and that number rises every year. In addition to reducing back pain and making women feel more confident, breast reduction surgery can drastically increase a woman's quality of life. Here's what you need to know about whether your insurance will cover the procedure:

Insurance and Breast Reduction Surgery

The first answer to women who wonder if insurance will cover their breast reductions is "it depends." While many insurance companies are happy to cover the procedure, each company is different and most use a set of criteria to determine if a plan will cover the surgery.

In most cases, insurance companies want to learn more about why a breast reduction is needed in your specific case and may evaluate the situation based on the following:

  • Presence of pain: Women with large breasts often experience back, neck and shoulder pain. Certain skin irritations or pressure on nerves may also be present.
  • BMI: Some insurance companies base their breast reduction coverage decisions on body mass index (BMI) and only cover the procedure if a woman's BMI is less than 30 or 35.
  • Weight of the tissue to be removed: If a plastic surgeon believes that the weight of breast tissue to be removed is between 450 and 600 grams, some insurance companies are more likely to cover the procedure.
  • Breast reduction as a post-cancer procedure: If a woman has had treatment for breast cancer and is undergoing breast reduction to get the breasts to match, insurance companies generally cover the operation.
  • Proof that breast reduction will improve quality of life: One of the main things insurance companies want to see before covering a breast reduction is proof that it will improve the patient's quality of life. Because of this, the insurance provider may request letters from plastic surgeons or other health professionals.

Boosting Your Chances

If you're considering breast reduction surgery in South Texas and are concerned about whether your insurance company will consider it a cosmetic surgery procedure, schedule a consultation with a plastic surgeon familiar with breast reductions.

In addition to offering you the best possible care, an experienced surgeon will also be able to help you navigate the waters of your insurance company and boost the chances that your provider will cover your breast reduction procedure. Dr. Matt Bindewald in San Antonio, TX is an expert in breast reduction surgery and employs a team of medical professionals well-versed in working with insurance companies on this procedure.

Read more about breast reduction surgery in San Antonio and South Texas here:

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