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Is a Breast Reduction Covered by Insurance?

A breast reduction with removal of a significant amount of breast tissue is considered by most plastic surgeons and patients to be a reconstructive procedure. Hoping to have the surgery paid for by their insurance, many find out that either this is not a covered benefit of their specific insurance plan or that they do not meet the criteria for surgery authorization.

What are the criteria that insurance companies require that you meet? These will vary from plan to plan and often are very stringent and difficult for many women to meet. You may need to have your symptoms explicitly documented such as neck, back and shoulder pains, negative effects on your posture, limitation of activities, skin rashes and even deep grooving of your shoulders from your bra straps. Some also mandate that you need to be below a specific weight for your height, have completed an extended course of physical therapy which did not resolve your symptoms, and that your plastic surgeon expects to remove a volume of breast tissue per side that exceeds a certain weight in grams. Letters from your primary care physician and other healthcare personnel strongly recommending this procedure are often needed as well.

If a breast reduction is not a covered benefit or your insurance company has denied authorization for the procedure, it may not be the “end of the world”. You still can elect to undergo the surgery but will have to pay for it out of your own pocket. Many of my patients do pursue this course of action because the symptoms from large breasts are so uncomfortable and limiting and the surgery is so effective in addressing them.

My office can help you to make this procedure a more affordable reality. We have package pricing available that significantly discounts your costs over what you would otherwise face in a hospital setting. For payment, not only do we accept several credit cards but we also offer you financing options from several companies that may meet your specific financial needs.

You can call my office at 480-451-3000 to obtain further information regarding a breast reduction or other procedure, insurance issues, financing options, or to schedule a consultation.

Steven Turkeltaub, M.D.
Scottsdale and Phoenix, Arizona