Health Insurance Coverage for Breast Reduction

Macromastia (Female Breast Hypertrophy), is the development of uncommonly oversized breasts in females. This condition can lead to major clinical exposures when the exorbitant breast weight negatively impacts the supporting shoulders, neck and trunk. Macromastia is differentiated from large, average-sized breasts by the existence of constant, painful problems and physical evidence. This painful condition can be corrected and the related signs and symptoms can be relieved by reduction mammaplasty surgery. Macromastia surgery is considered reconstructive in its intention and should be compensable by insurance plans that provide coverage for reconstructive surgery. When breast reduction is done mainly to make a patient's appearance in better without any evidence and/or signs of  operative irregularities, the procedure should be considered cosmetic in distinction. The ASPS feels that when reduction mammaplasty is perfomed in a cosmetic intention it is not a compensable procedure unless specifically indicated in the patient's insurance policy.

However, each insurance company has their own unique requirements for approving breast reduction.  The basic requirements include:
Symptoms ; Your cosmetic surgeon will make your appointment history to send to your insurance provider.
Be organized and get all of the past doctor, chiropractor, and physical therapists records that support your case.  These ususally include weight loss, postural training, back therapy, anti-inflammatories and more.  The length of treatment is singnificant with some mandating six months.
The majority of insurance companies will look at your BMI (Body Mass Index) and could rule a denial if you are overweight.
500 grams of breast tissue to be removed.  Some insurance companies have raised this guideline to 600 grams while some use the BMI as a guide to weight removal 
Photos; Your plastic surgeon may submit photos for authorization.