Q) Three years ago I got a doctor recommendation to get a breast reduction. I lived in South Carolina, was on Medicaid, and I was told to lose weight in order to receive approval for the breast reduction. I now live in Georgia where I am experiencing the same back problems and dealing with extra breast tissue under my right arm. I’d like to know if my insurance would approve my reduction now that I’ve been at my job for over a year. I am on Aetna PPO insurance and my breast size is 42 DD.
A) Whether or not your insurance covers your breast reduction will depend on certain factors. First, is your physician in network or out of network? Not all physicians participate in insurance plans, especially plastic surgeons. If you’d like to stay in network, meaning that you will have no payments or a limited number of payments, you should find which plastic surgeons participate in your plan. Second, does you health insurance plan cover breast reduction surgery? Not all plans cover all surgeries. It is up to your employer providing you with your health plan to decide if the plan covers all procedures. Unfortunately, you may not be able to find out unless a code is created after being examined by a physician. The insurance company uses this code to decide whether or not the procedure is covered. If you go to a network provider then you just need to bring your insurance information with you to the examination. All of my patients who have undergone a breast reduction tell me it has improved their lives drastically. Good luck!