Our team believes the cost of a breast reduction should not outweigh the life-changing results the procedure can provide. Whether your overly large breasts are a cosmetic and/or medical problem, Richmond Aesthetic Surgery strives to make reduction surgery possible for all budgets. See below for more details about how you can get insurance to cover your breast reduction, as well as other information about financing to help with the total cost of your procedure.
Insurance Coverage for Breast Reduction
Depending on the details of your breast reduction, your insurance may cover part or all of your surgery cost. In fact, around 75% of patients who have a consultation for the procedure may qualify for insurance coverage. This is due to the medical need to reduce breast volume and weight.
Common problems women seek to alleviate with a breast reduction include neck and shoulder pain, back pain, skin rashes beneath the breasts, and grooves from bra straps. Whether insurance covers a breast reduction will depend upon the duration and severity of these symptoms. It will also depend upon the insurance carrier. Currently, Richmond Aesthetic Surgery works with Anthem Blue Cross Blue Shield (BCBS) insurance for breast reduction surgery.
If you are considering breast reduction, you should first read your insurance policy. For some, a “reduction mammoplasty” (breast reduction) may be a policy exclusion, which means the surgery is not covered despite being medically necessary. By understanding and preparing for the insurance process, you can navigate the approval journey more smoothly and ensure you receive the coverage you need for your breast reduction.
In addition to your personal health insurance, Richmond Aesthetic Surgery offers the option of CosmetAssure®—a cosmetic surgery insurance program. Those who opt to receive this coverage can recover from their breast reduction knowing that should a rare complication occur, they are covered up to the maximum limits of their policy. Coverage with CosmetAssure® lasts for the first 45 days after surgery with a plastic surgeon.
What Documentation Is Needed for My Insurance?
To increase the likelihood of your breast reduction getting approved by your insurance, thorough documentation is essential. This includes:
Letter of Medical Necessity from Your Surgeon
Before your breast reduction surgery is scheduled, most insurance providers require your surgeon to write a letter detailing your symptoms, physical assessment, and the approximate amount of excess breast weight, as well as a request for coverage. If insurance coverage is denied due to the procedure being considered cosmetic in nature, your surgeon can inform the insurer of your medical need and how reduction differs from a breast lift, which is considered cosmetic.
Medical Records Documenting Symptoms and Prior Treatments
Detailed medical records are needed to help support your insurance claim for breast reduction surgery. These should document your chronic symptoms like back, neck, or shoulder pain, and any skin issues. Including records of prior treatments, such as physical therapy or pain management, also helps demonstrate the medical necessity of the surgery, increasing the likelihood of insurance approval.
Photographs of Your Breasts
Pictures are necessary to illustrate the physical issues caused by the size of your breasts, helping your insurance company understand the medical necessity of the procedure. Our office will guide you on how to take and submit these photos correctly.
How Long Does It Take to Get a Breast Reduction Approved?
The approval process for breast reduction surgery varies by insurance provider and policy. It begins with a consultation where your surgeon assesses your condition and recommends surgery based on potential medical necessity. This recommendation, along with the detailed documentation explained above, is submitted to your insurance company.
Approval can take anywhere from a few weeks to a few months, depending on how quickly your insurance processes the request and whether additional information is needed. To expedite approval, ensure all required documentation is complete and submitted promptly. Our office can help navigate these requirements and communicate with your insurance provider.
What if My Insurance Denies My Breast Reduction Coverage?
If you receive a denial but feel a reduction is necessary for your day-to-day living and overall health, you have the legal right to send an appeal. How you can go about this appeal process should be explained in your denial letter. It can be helpful for you to write your own letter describing the side-effects of your overly large breasts and how they prevent you from normal daily function, emphasizing your chronic physical symptoms.
Also helpful, you should obtain a letter from other health professionals, such as a family doctor, physical therapist, chiropractor, or orthopedist, to further support your appeal. You can ask your doctor to submit these letters as well as the latest scientific findings and medical publications about the permanent treatment of breast reduction to create a strong argument against your denied coverage.
Does Medicaid Cover Breast Reduction Surgery?
Yes, Medicaid can cover breast reduction surgery if it is deemed medically necessary. Coverage criteria include chronic pain in the back, neck, or shoulders, skin irritation, or infections that do not respond to other treatments. The specific requirements for approval can vary by state. Comprehensive documentation from a healthcare provider, including medical records and possibly photographs, is essential to support the claim.
For more details regarding Medicaid coverage in Virginia, you can refer to the Cover Virginia website, which provides comprehensive information on Medicaid services and eligibility.
Breast Reduction Financing Options
After you have had the chance to consult with our plastic surgeon, you will be provided with a quote of how much you can expect to pay. Should the estimated cost of your breast reduction be outside of your budget, our staff can work with you to find a way to make the procedure more affordable.
Our practice offers financing through CareCredit® and Cherry to help make your breast reduction a reality. These companies provide a variety of low monthly payment plans and different interest rate options to help you find the best financing for your situation.
The application process for Cherry is quick and provides instant approval options without any hidden fees. Applying for CareCredit® is also typically a fast, simple process, and you can do so over the phone, online, or by fax. If you have any difficulty applying for financial assistance, our knowledgeable staff can help guide you through the process.
Schedule Your Consultation
If you have any questions or concerns, please feel free to contact us, and one of our team members will be happy to assist you.
