Is breast reduction plastic surgery covered by insurance?

A patient may require breast reduction cosmetic surgery for aesthetic reasons, functional reasons, or both. Oversized breasts may not only be unsatisfactory to a woman from an aesthetic viewpoint but may also be a reason for discomfort and pain.

Excessively large breasts can lead to constant pain in areas such as the neck, back, and the site where the bra straps support the heavy breasts.

Other than discomfort and pain, a woman with oversized breasts may find it challenging to undertake specific physical activities, exercises as well as routine chores involving bending and lifting heavy objects. The functional problems may encourage a woman to consider a breast reduction procedure to enhance the quality of her life.

Beverly Hills Plastic Surgery, led by sagacious plastic surgeon Dr. David Kim, provides breast reduction surgery to patients in Beverly Hills, Los Angeles, and surrounding communities across the horizon.

Insurance Coverage for Breast Reduction

Breast reduction plastic surgery may or may not be covered by insurance. Every medical insurance provider has different policies about such surgery.

If the insurer believes that the breast reduction procedure is necessary medically for an individual policyholder, they may offer coverage for the surgery. It is essential to understand what portion of the surgery will be covered by insurance. The typical cost elements of a breast reduction surgery are:

• Surgical facility or hospital costs
• Anesthesia costs
• Surgeon’s fees
• Medical tests costs
• Prescription medication costs
• Post-op surgical garment costs

If the medical insurance company views breast reduction as a medically necessary procedure, the total cost of the surgery may be covered.

But the patient must be able to show the insurer that the procedure is necessary for relief from the medical problems arising due to excessively large breasts. Several health insurance companies will accept breast reduction surgery as medically necessary contingent to the breast tissue percentage that needs to be eliminated.

This factor is an indicator for the insurer in evaluating how critically the patient requires a breast reduction procedure for medical purposes. The patient will usually need pre-certification for breast reduction insurance coverage or reimbursement. Patients who depend on the insurance coverage for this surgery should go ahead with the procedure only after they clear all formalities with their health insurance company.

Determining Coverage Status

Patients should contact their insurance company directly prior to commencing with the breast reduction process. In many instances, the insurer will ask for a letter of certification from a physician explaining that the patient is suffering from pain and discomfort resulting from oversized breasts.

The insurance provider may also ask for a letter from the surgeon before the procedure. This letter will detail the surgeon’s assessment on the amount of breast tissue that requires removal.

Even if such efforts result only in partial coverage for the surgery, it can be a considerable financial support for the patient. Dedicated cosmetic surgeon Dr. David Kim receives patients from Beverly Hills, Los Angeles and other cities and towns in this area of SoCal for breast reduction.

For more information on the surgical and non-surgical procedures and treatments by Cosmetic Plastic Surgeons Dr. David Kim and Dr. Eugene Kim, contact us (310) 271-6996 at or click here.

Serving Beverly Hills, Los Angeles, West Hollywood, Orange County, Southern California and surrounding areas.