Does Insurance Pay for Breast Reduction?

Breast reduction, or reduction mammoplasty, is a transformative procedure that many women consider for both medical and aesthetic reasons. The surgery involves the removal of excess breast tissue, fat, and skin to achieve a breast size that's in proportion with the patient's body. But one of the most pressing questions for many considering this procedure is: Does insurance cover it?

The Medical Necessity of Breast Reduction

For many women, large breasts can cause significant physical discomfort, including back pain, neck pain, and skin irritation. These symptoms can interfere with daily activities and even lead to long-term health issues. When breast reduction is sought primarily to alleviate these physical symptoms, it's often considered a medical necessity rather than a purely cosmetic procedure.

Insurance Coverage for Breast Reduction

Insurance policies vary, but many providers in Portland, OR, do offer coverage for breast reduction surgery when it's deemed medically necessary. Typically, insurance companies require documentation of symptoms, such as:

• Chronic neck, back, and shoulder pain.

• Skin issues, like rashes or infections, under the breasts.

• Shoulder indentations from bra straps.

• Limitations in physical activities due to breast size.

It's crucial to consult with your insurance provider and understand the specific criteria they require for coverage. Some insurers may also ask for photographs or a recommendation from a primary care physician or physical therapist.

Costs Involved in Breast Reduction

While the benefits of breast reduction are numerous, understanding the financial aspect is crucial for those considering the procedure. If insurance covers the surgery due to medical necessity, it can significantly reduce out-of-pocket expenses. However, the exact coverage and potential costs can vary based on your insurance provider, the surgeon's fees, the facility where the surgery is performed, and other related expenses such as post-operative care and medications.

For those whose insurance does not cover the procedure, or for individuals seeking breast reduction primarily for cosmetic reasons, the surgery can still be pursued as a cosmetic procedure. In such cases, it's essential to discuss financing options and payment plans with your chosen plastic surgeon. While cosmetic procedures typically come with out-of-pocket costs, many clinics offer flexible payment options to make the procedure more accessible.

It's essential to consult with both your insurance provider and your chosen plastic surgeon to get a comprehensive understanding of all potential costs involved, ensuring there are no unexpected expenses down the line.

FAQs

• How much does a breast reduction cost in Portland?
  The cost of a breast reduction greatly depending on an individuals insurance plan and coverage.

• How do I get insurance to cover breast reduction?
  The procedure should be deemed medically necessary and provide the required documentation and evidence of physical symptoms.

• What size breasts qualify for reduction?
  There's no specific size requirement, though many insurance companies do require documentation based on body surface area and estimated breast weights to be removed.

Breast reduction surgery can offer relief from the physical and emotional challenges of having overly large breasts. If you're considering this procedure in Portland, OR, it's essential to consult with a trained plastic surgeon like Dr. Aaron Gilson and thoroughly research insurance coverage options.

-Dr. Aaron Gilson
Gilson Plastic Surgery
Portland, Oregon