I have DDD breasts, back pain, and they just look terrible after kids. I want to get a breast reduction, but I don’t know how to go about it. Do some insurances cover it? I’m on priority partners, which most likely doesn’t. What’s the typical cost range for one? I’m located in MD
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Kristy DeHoff might be able to answer this.
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I also live in Md and have priority partners. Someone told me to go to my primary doctor to complain of rashes I get between my legs for a tummy tuck. So I would start there and just express all concerns. Never hurts to ask.
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First thing I would do is get your doctor to document that your size is affecting your health. Then find a reputable plastic surgeon to talk with about costs and insurance. Then also check with your insurance company about what qualifies.
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I was in the same situation years ago…my primary care provider noted my complaint…my insurance covered 
of procedure… it’s considered plastic surgery…find a good one and have a consultation.
I love my boobies now 
. Good luck 
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Most insurance will cover it if your doctor says that it is causing back pain and affecting posture negatively.
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Most insurances will cover if it’s proven by a doctor it’s effecting your health. My mother had a breast reduction couple years ago (42DD) and was fully covered by Medicaid because she had documentation proving it was effecting her
Possibly if dr advises it and it’s a medical issue
If they are causing back pain or health problems then most insurance should cover it with preauthorization with doctors explanation
I believe most insurances consider it cosmetic. You have to prove that it causes actual medical problems. I have a friend who’s wanted to get one for years as well with no real luck
Mine covered it. I was an E. Make sure your doctor is aware of your concerns and start researching plastic surgeons in the area. If there are medical concerns, your surgeon will be able to document this & submit to your insurance.
I had mine done 5 yrs ago. Was fully covered under Maryland Physcians Care. Just needed dr documentation that it was needed for my back.
Go to the chiro first. That’s what I did. He wrote a recommendation to a plastic surgeon and the plastic surgeon wrote a letter to the insurance company. All I had to pay was my co pay. Message me if you have any questions!
I had mine done almost 20 years ago. Insurance paid for it but we had to cover deductible first. Just had to have a recommendation from an md saying it was negatively affecting my health.
They were covered for my mom because of the damage it was doing to her back
Don’t know what company she had, but I know my sister’s was covered because she got official documentation from her doctor that the weight of her breasts was a health concern. She now encourages everyone with big boobs to get one. She says it’s the best thing she’s ever done in her life.
Where i live it is free if recommended by the family doctor. 
You can also access super to have it done if recommended by a doctor.
Yes! If it’s causing back pain ect your dr will send you to a surgeon and if required medically it’s all covered. Oh sorry just saw this was in md.
Sometimes your doctor can get an exception for you if they can provide evidence that you will need several back surgeries resulting from the size of your breasts. They would prefer to pay for one surgery that resolves the cause and prevents further expenses, as opposed to paying for multiple surgeries. But you’d have to discuss this with your doctor/surgeon.
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It is a long process but they will take pictures and decide if they feel it’s necessary or not. Like others said if you would have to have other surgeries due to problems from your breasts they would rather pay for one than multiple. I got the surgery done when I was 15. It was a difficult decision as I just got a boyfriend and was going through high school. But it is the best thing I’ve ever done. I went from an H cup (yes an H!) to a C. Now that I’m pregnant I’m up to a DD again but am still pleased with my choice. My boyfriend at the time was supportive and is now my husband.
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Every plan is different and has different rules. First check your insurance itself and find any medical policies that may apply, you can literally google “medical policy for breast reduction surgery for BCBS” and find one if one exists
Then you have to call your health plan to get your plans coverage information specifically to see if it is something that your health plan has benefits for
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Like others said it’s up to the insurance company. The consider it medically necessary if they have to take more than a certain percentage of tissue because it’s understood that it’s giving you other issues like back problems neck problems something like that so you just need to see a doctor about it and get it documented the issues you’re having and then see a plastic surgeon about it and let them try to get it approved for you using your other doctors records that it’s medically necessary and the plastic surgeon’s that it’s medically necessary and get preapproval for it. I did way back in 1985 or something like that and it’s one of the best decisions I ever made.
You need to just call your insurance company. Because they all have several policies. Each ones covers different things.
Yes some insurance does pay, especially if you’re having back problems. Talk to your dr
I had one done and insurance covered it. Once you see plastic surgeon he/she knows what to do to get it approved.
I just asked my obgyn about this 2 weeks ago. She said insurance will not cover even with back issues. She said only way insurance will cover is if you have cancer. I’m in TX with BCBS.
My maternal grandmother and mom both had breast cancer, my sister had DD cups and was in back pain and wanted a reduction, they did genetic testing to see if the breast cancer was genetic or not, it wasn’t, but if it was the insurance would have covered the reduction because it may have helped her from getting breast cancer
If you can get your PCP to say that it’s medically necessary then your insurance will cover all of it.
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My daughter was 14, same situation as you. Dr’s appealed for us and got it approved due to it being medically nessacery. She was miserable.
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My doctor sent me to a plastic surgeon and insurance approved it within 3 weeks…my surgery is the 25th…talk to your doctor to begin the process
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The easiest answer is to personally call your insurance provider and ask questions! They will start off more than likely saying no coverage. Ask what constitutes medical necessity? This should give you the guidelines on what determines medical necessity therefore the exception to no coverage for breast augmentation. It is typically a certain amount of tissue being removed. I processed medical claims for a local insurance company for almost 25 years! So remember there are almost always exceptions to the rules!
In ca some insurances will cover it if the dr writes a letter stating that it is creating a health issue