How to Get Health Insurance to Cover a Breast Reduction

Sometimes a breast reduction is a medical necessity that may be covered by your insurance. Find out what you need to qualify for surgery and be reimbursed.


  • Step 1: Prove that you are predisposed to breast cancer by having a family history or pre-cancer markers, and your insurance may cover the costs of a preventative, breast reduction mastectomy or mammaplasty.
  • FACT: There were just over 113,500 breast reductions performed in 2009, a 137 percent increase over 1997.
  • Step 2: Consider that even if your insurance company agrees to cover the surgery, if your surgeon decides you need implants to reconstruct the breasts, you may have to cover that portion of the operation out-of-pocket.
  • Step 3: Know that your insurance company may require that you try other options, like losing weight or going through physical therapy, before approving a reduction.
  • Step 4: Get a referral from a primary care physician, who must recommend you have breast reduction surgery due to disabling symptoms. You may then meet with a plastic surgeon to discuss the procedure in detail.
  • TIP: To be deemed medically necessary, a surgeon must estimate they will have to remove a certain amount of tissue from each breast based on your height and weight, usually about 500 grams or 1/2 pound.
  • Step 5: Assess your insurance plan to find out if breast reduction or other elective surgery is covered. If not, you may opt to change your plan's coverage to meet this need. Contact your insurer and find the documents you need to secure pre-authorization for surgery.

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