Skip to main content
Book An Appointment

Dr. Linder's Blog

Coverage For Insurance Regarding Breast Reduction

Posted On: April 20, 2011 Author: The Office of Dr. Stuart Linder Posted In: Breast Reduction, Uncategorized


Breast reduction surgeries are functional operations. Patients present with horrendous symptoms of massive amounts of back pain, neck strain, grooving of shoulder blades, rashes and so forth. All insurance companies have different policies and plans. PPO plans often will cover breast reduction surgeries if the patient is going to be having a certain amount of tissue removed per breast and the symptoms have been documented. They often require documentation of upper back pain and shoulder pain not associated with any other diagnosis, including photographs showing grooving along the shoulder blades, as well as frontal, oblique and lateral views of the breasts. They may require documentation of ulcerations of skin as well as documentation of physical therapists and chiropractors showing failed measurements and may also require radiographic evidence of x-rays showing kyphosis or vertebral column abnormalities associated with the massive breasts. Intertriginous or chronic skin breakdown that is not responsive to the dermatological medications may also be needed to be proven. The amount of breast tissue to be removed is different per policy. There are total body surface area policies where height and weight ratios are reviews and times by a factor in order to give a specific gram weight that must be removed per breast. The height and weight of the patient are always required and those are often needed to determine the amount of tissue removed per breast.

Reduction mammoplasty is a functional surgery. This is a surgery where patients do great. If the tissue is removed appropriately and safely, the results are fantastic and the patients couldn’t be happier.