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lovetoteach 02-04-2008 05:13 PM

When is a breast reduction medically necessary?
I understand some women elect to have breast reduction for cosmetic reasons but when is medically necessary? Does insurance ever cover it if you are experiencing moderate to severe upper back pain from "carrying too much weight" up there? I personally don't have this issue but my daughter does who's only 17.

judy 02-08-2008 03:49 PM

It's 'medically necessary' if they're big enough to the point where it gives you back pain. I think for insurance reasons you also have to be at your ideal weight i.e. if you are overweight the insurance will deny it because they'll tell you to lose the weight first.

desperatehousewife 02-10-2008 01:21 AM

Here I pulled this up for you. It's from the Mayo Clinic website - hope this makes it more clear for you.


Is breast reduction surgery covered by insurance?

It might be. Insurance providers stipulate that the procedure be medically necessary, not cosmetic. To meet the standard of medical necessity, you might be required to have your breasts reduced to a predetermined size shown to provide significant symptom relief. To be sure you're covered, check with your insurance company beforehand.

joan7 02-11-2008 03:29 PM

Be prepared for insurance to put you through the ringer first more often then not. First your physician will need to certify you're at a ideal weight and have been for a while. If not they'll want you go to get to that magic number and often stay at that weight for a period of time to see if you still have the pain. Then again I've heard of insurance covering breast reduction right away too. It all depends on the company. I think the universal requirement however is the idea weight before surgery authorization. Good luck!

michell 07-25-2008 10:08 PM

But thers a bad news.Insurance Companies Deny Medically Necessary Breast Reductions Based On Random, Unproven Criteria.

I got an recent extract ( What if you couldn't perform daily activities, such as exercising or running with your children, because of overly large breasts that caused unending pain? Despite existing scientific studies that outline the medical necessity for breast reduction, many insurance companies are denying thousands of women the procedure each year because of rigid, unfounded conditions to secure coverage, according to a study presented at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco.

"People often think breast reduction is an elective cosmetic procedure, but the majority of women seeking this surgery are legitimately debilitated by their breasts," said Michael Wheatley, MD, ASPS Member Surgeon and paper co-author. "The criteria most insurance companies use is not supported by medical literature and eliminates a large number of women from coverage, forcing them to fend for themselves." )

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