Breast Reduction Insurance Coverage

Is a breast reduction
considered medically necessary?

Macromastia (large breasts) can cause medical issues such as back pain, neck pain, rashes in the skin folds. If those symptoms are present, a breast reduction is considered medically necessary by some, if not most, health plans. There are a lot of published studies showing relief of back pain and neck pain following a sizable breast reduction.

Does insurance
cover breast reductions?

Each insurance company has their own coverage policies. We have seen some insurances in the Washington DC area and Maryland areas that simply exclude any coverage on breast reductions, but the vast majority will consider covering a breast reduction if certain criteria are met. These criteria may vary. The best thing is to call the insurance company and ask them to send you their coverage criteria for breast reduction.

Does insurance cover breast lifts?

Not unless a reduction is being covered. Patients that simply want a breast lift without a reduction are typically not covered as this is considered by most insurance companies to be cosmetic.