What are the coverage requirements for a breast reduction & lift?

Tags: age 25-34 5 ft 0 in to 5 ft 3 in 90-109 lbs cost back pain insurance

I am 5’1 and weigh 102 lbs but my breasts are a size 36D. Because of my small body frame, my large breasts are causing me to have back pain and it has been this way for some time. I have tried seeing a chiropractor for my back but it doesn’t help, I feel like the only solution is a breast reduction w/ a lift as once I am a smaller size that will alleviate the pain. I would really like to see if my insurance will cover at least a portion of the surgery. Can you tell me what the coverage requirements are for a reduction & lift?


F, 33, Utah

Hi.  Sounds like you would be a great candidate for breast reduction to improve your complaints and symptoms!  Although all insurance companies have specific requirements, they all want to make sure that you have a functional problem that has not been able to be improved without surgery.  So they want documentation that you have tried pain medication, physical therapy, topical medicines from rashes, attempted weight loss, etc.  They will also usually have a requirement of how much breast tissue needs to be removed.  You will likely qualify, so your next step should be an in-person consultation with a PS who is experienced with breast reductions.  Best of luck!

I imagine you'll be a candidate. Shoulder, back, neck pain, rashes, bra strap grooving, weight loss/physical therapy/anti-inflammatories ineffective, are some of the buzz words the insurance companies are looking for. I think calling it a breast reduction (not a lift) will make insurance companies more agreeable in a letter of medical necessity (since a lift sounds cosmetic). They often require a minimal weight of reduction for coverage, although it's not always policed. Also, if there is coverage, it may only cover a portion of the surgeon's fees if he or she is out of network. If you go in network, then again, be very picky! A breast reduction should be a beautiful work of art!

Dr. Jonathan Zelken has 3 Breast augmentation, Breast lift, Tummytuck before & afters:

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