Breast Reduction

Serving San Francisco, San Jose, & Walnut Creek, California

Breast Reduction Insurance

Qualifying For Insurance Coverage

The main reason that your insurance will pay for your breast reduction is that it is medically required. As such, it is considered reconstructive surgery to restore normal body structure and not cosmetic surgery to (only) enhance your appearance and self-esteem.

Although reconstructive surgery will likely also have other benefits in addition to alleviation of medical problems, including enhancing your appearance and self-esteem, insurance will only cover specific medical conditions.

To qualify as a medical reconstructive procedure, the surgery must be performed to correct various physical conditions resulting from excessive breast tissue weight which may include the following.

• Upper back, neck and shoulder pain.
• Postural backache resulting from curvature of the spine due to excessive and imbalanced weight distribution.
• Shoulder grooving due to excessive weight on bra straps.
• Breathing problems due to excessive weight pressing down upon the chest.
• Inflammation of the body fold on the underside of the breasts known medically as intertrigo.
• Inflammation or compression of the ulnar nerve, also known as ulnar paresthesia (numbness, tingling, and pain) in the outer side of the arm and hand near the little finger.
• Other general symptoms including breast pain, inability to loose weight in the breast, and inability to participate in normal physical activities or exercise.

In addition, an insurance company will typically require the following.

• An examination by a surgeon, physician or other licensed M.D. that indicates you have macromastia also known as female breast hypertrophy or excessively large breasts.
• The planned breast reduction volume is equal to or exceeds the minimum required by the insurance company for your height and weight.
• You are within your normal height and weight range.

Obtaining Insurance Coverage

If you qualify for insurance coverage for your breast reduction because you have various obvious medical conditions and physical symptoms, then the next step is to find a breast surgeon who can effectively work with your insurance company.

The following attributes and capabilities would be advantages for actually receiving an insurance award.

• The surgeon has sufficient experience and takes the time to fully and completely diagnose and record your medical problems and physical attributes. These records will be vital in any insurance claim.
• The surgeon's office has a proven track record of effectively and efficiently processing insurance claims and receiving awards for qualified cases.

More Information About Insurance Coverage

For specific information regarding your case for insurance coverage for breast reduction, please call us at 415-567-9619 or e-mail our breast surgeon.

Randall B. Weil M.D., F.A.C.S

San Francisco Board Certified Plastic Surgeon

909 Hyde St., Ste. 602, San Francisco, CA 94109 | 415-781-2081