Friday, December 16, 2011

Breast Reduction Covered By Insurance?

For some women, having large breasts means experiencing pain every single day. This condition, also known as macromastia, often causes physical pain and brings about emotional distress. While some women may learn to live with the physical and emotional hardships that come with having large breasts, others want to address this condition with reduction mammaplasty (breast reduction). For my patients in Los Angeles, a breast reduction can enhance self-confidence in addition to providing physical relief.

Breast Reduction Methods

Before discussing insurance coverage for breast reduction, it is important to understand the surgical methods available to achieve more proportionate breasts. The goal of any reduction procedure is to remove excess fat, breast tissue and skin. There are different types of incision methods, largely dependent on how much breast tissue or fat needs to be removed.

Anchor-Shaped Incision: This method uses an incision circling around the areola, descending down vertically toward the bottom of the breast, and running horizontally along the crease of the breast. The nipple (still attached) is then moved to a higher position on the breast, and the excess tissue, fat or skin is removed. The breast is then lifted and tightened.

Lollipop Incision: This technique is typically utilized when less skin or tissue needs to be removed. Also known as the short-scar method, the incision encircles the areola and descends vertically down the breast. Excess skin and tissue is removed at this time.

Liposuction: Liposuction may be performed along with a breast reduction to help reshape the breast. While not always used with breast reduction, liposuction can help remove fat from under the arms and around the bottom of the breast crease. It can also be performed on its own as a way to reduce the size of the breast, but this is not very common.

Insurance Considerations

Because this procedure is far more than cosmetic, many insurance carriers will offer full or partial coverage for breast reduction surgery. However, many women remain unaware of what their insurance will cover. In almost all cases, an insurer will require that the procedure is being performed for medical reasons in order to extend coverage.

Often, the physical discomfort of large breasts is one of the factors in determining insurance coverage. Some of the physical difficulties associated with having large breasts include stretched skin, back and neck pain, headaches, poor posture, grooves in the shoulders from bra straps, and the inability to exercise.

Before insurance companies cover the cost of a breast reduction procedure, they first need to make sure that oversized breasts are not the result of being overweight. For heavier patients, Insurance companies require a larger amount of breast tissue to be removed for the surgery to be covered.

Your Individual Case

Some patients' insurance companies cover the entire cost of the procedure, while others cover only a portion of the cost. Not all insurance companies provide the same coverage. After meeting with a surgeon and determining if you are a good candidate for breast reduction surgery, submitting necessary documents to insurance companies is important as pre-certification is required for reimbursement or coverage. As a final note, for those who have had a mastectomy and require a breast reduction on their normal breast to achieve symmetry, under federal law, insurance companies are required to pay for the cost of this procedure.