Will Insurance Cover My Breast Reduction Surgery?

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Breast reduction surgery is often more than just a cosmetic procedure. Patients requesting this procedure may be suffering from uncomfortable physical symptoms due to disproportionately large breasts. For some of these women, the procedure may be deemed “medically necessary” by their insurance company, which allows them to use their coverage for their procedure. However, the formulas used by insurance companies to determine medical necessity can be complex and it is important to understand the factors involved before you schedule your breast reduction procedure.

Physical Symptoms and Non-Surgical Treatments

Large breasts can cause a number of uncomfortable symptoms, including:

Back, neck and shoulder pain

Painful grooves from bra straps on shoulders

Skin irritation and rashes beneath the breasts

Numbness in the arms and hands

Physical symptoms typically must persist for a set period of time, as determined by the insurance company. In addition, many companies require women to try non-surgical treatments for their symptoms first, such as oral pain medication and physical therapy, before surgery is considered a viable option.

Providing Documentation

Even if your insurance company preauthorized your breast reduction surgery, proper documentation will need to be provided to obtain approval from the insurance company for the procedure. This documentation usually includes photographs, a list of symptoms and treatments already performed, a letter from your physician describing your physical symptoms and an assessment of your condition based on the Schnur scale.

The Schnur Scale

The Schnur Scale was developed by a plastic surgeon and is used as a method of evaluating the medical necessity of a breast reduction. Your insurance company will use the scale to compare your body surface area to the amount of tissue your surgeon has recommended for removal and determine if you truly need a breast reduction for medical reasons.