Are Breast Reductions Covered by Health Insurance?

Breast reduction surgery is a common procedure that involves removing fat, tissue and skin to reduce the overall breast size. Depending on your reasons for seeking this procedure, it can have a big impact on your comfort, health and quality of life.

Does Health Insurance Cover Breast Reductions?​

Breast reductions are typically sought out by those whose breast size causes problems such as:

• Nerve pain
• Improper fitting clothing
• Neck, back or shoulder pain
• Skin irritations such as heat rashes and eczema beneath the breasts
• The inability to engage in activities such as running or jogging

While women make up the majority of those seeking breast reduction surgery, men account for about 40% of procedures. On average, this type of surgery costs $5,913. This figure does not include costs such as anesthesia or operating room facilities and may be higher or lower depending on where you live and your surgeon’s level of experience.

Why Are Breast Reductions Not Automatically Covered?

Unless you can prove that breast reduction is medically necessary, it is considered to be a cosmetic elective procedure, and your health insurance policy will not cover it. However, if it is deemed medically necessary for your health as stated in the reasons above, your procedure most likely will be covered. Of course, you’ll be subject to your plans’ deductible and other costs.

How to Get Breast Reductions Covered

Your health insurance company wants you to exhaust other options before scheduling a breast reduction surgery. The exact process varies from one health insurance company to the next, but in most cases, the individual and their doctor may have to provide documentation that proves the surgery is necessary to resolve underlying health problems.

Unfortunately, this can be a lengthy process. Health insurance companies may require up to 12 months of documentation to prove that an underlying health problem exists and that you have tried to treat it through other avenues. The company may require that you first seek treatment from a physical therapist, dermatologist, orthopedist, or chiropractor. Once these treatment options have been shown to be ineffective in correcting the problem, only then is there a chance of coverage for breast reduction surgery.

After the necessary documentation has been turned over to the health insurance company, there is typically a three- to six-month turnaround time before the company gives approval for the procedure. During this time, the health insurance company may communicate with your doctor and other licensed health care professionals to confirm that the surgery is medically necessary.

Choosing the Right Health Insurance Policy with Nevada Insurance Enrollment

There is no such thing as a one-size-fits-all health insurance policy. Your unique health and lifestyle factors, including surgeries that you expect to have in the future, should influence the policy you choose. At Nevada Insurance Enrollment, our experienced health insurance agents can help you find the policy that fits your needs and budget and provides the coverage you need. We can also help you understand your health insurance policy’s coverage for breast reduction surgery and navigate the process of getting your procedure covered.