Will Insurance Pay For My Breast Reduction Cost?

Breast reduction surgery has one of the highest patient satisfaction scores of any plastic surgery procedure. For many women it is a life changing procedure that provides substantial quality of life and related health benefits…but that doesn’t mean that insurance is going to cover it.

Every insurance plan has specific requirements that determine whether or not they will cover breast reduction surgery. Almost all plans require removal of a minimum of 500g of tissue per breast. 500g is a lot of tissue. Patients who want a small reduction or need less removed won’t qualify. Plans may also require physical therapy, weight loss, and medical records documenting related health issues before they will consider approval. Will insurance cover your breast reduction? The answer for many women is simply no.

This patient had 424g removed from each breast. She has wonderful results, but she won’t qualify for insurance coverage.

Dr. Mess does not participate with insurance. Patients pay out of pocket for their reductions. Some do pursue reimbursement from their insurance company, and we will help to make sure they have the required documents to submit for approval, but it’s important to remember:

1. Dr. Mess is out of network with insurance, so you need out of network benefits for your insurance to consider your claim.

2. Insurance will not reimburse you the full amount of your surgical costs, so expect to pay the full amount. (Breast reduction costs range from $9,000 to $11,000. Even if your insurance company approves your procedure, you will likely only be reimbursed a fraction of that cost, $1,500-$3,000.)

3. You many need get a pre-authorization for the procedure so check with your plan before you have the procedure. A pre-authorization is not a guarantee that your insurance company will ultimately pay for the procedure.

4. If you do get approval, it may take several months before your insurance company reimburses you for the procedure.

Dr. Mess is focused on results, not just on a number. She is going to give you the best breast reduction results possible, whether it’s a 600g or a 400g reduction. Will insurance pay for my breast reduction? The answer is usually no, and our patients understand that. Please contact us to schedule your consultation today.