What is the Difference Between Cosmetic And Insurance Breast Reduction?, NC*

Many women considering breast reduction wonder whether or not it will be covered by insurance. There are number of conditions that have to be met in order for insurance to cover breast reduction. This includes documentation of health concerns related to large breasts such as neck pain, back pain, shoulder pain as well as rashes under the breasts. Primary care physicians must provide this documentation. In addition, there must be evidence that measures were taken to address these symptoms such as potential weight loss, use of NSAIDs, physical therapy or chiropractic manipulation. None of these measures really change breast size and in most patients, are unlikely to improve these symptoms long-term. Insurance companies also require a certain amount of breast removed -determined by body surface area -and other physical measurements must be made such as sternal notch to nipple distance which gives evidence of breast ptosis. This 55-year-old woman desired breast reduction. Although she suffered neck and back pain she had not done much in the way of gathering documentation or undergoing treatment and she was anxious to have the procedure performed. She did not meet criteria based on sternal notch to nipple distance. She underwent elective breast reduction as self pay-with removal of 1 pound of tissue from the right side and 1.3 pounds on the larger left side. She was very happy with her smaller cup size going from an E cup to a small D and her symptoms improved.