When Is Breast Reduction Considered Medically Necessary?
Insurance companies typically cover breast reduction only when it’s deemed medically necessary. This usually means you’ve experienced ongoing issues caused by disproportionately large breasts, such as:
- Chronic neck, shoulder, or back pain
- Painful shoulder grooves from bra straps
- Skin irritation or rashes beneath the breasts
- Nerve compression or posture-related issues
- Difficulty with physical activity or exercise
In most cases, your insurance provider will require documentation from a medical professional confirming that these symptoms exist and that other treatments — like physical therapy, weight loss, or supportive garments — have not provided sufficient relief over an extended period of time.
What Documentation Do You Need?
To pursue insurance coverage, you’ll need detailed medical records supporting your case. This includes a history of symptoms, treatment attempts, and a letter of medical necessity from your primary care physician or another provider. Some insurance plans also require photographs and measurements, as well as a certain estimated amount of tissue to be removed, based on body size and proportion.
At Watterson Plastic Surgery, we can guide you through this process and help gather the materials needed for pre-authorization. Please let us know during your consultation if you’re interested in using your insurance, and we’ll assist with the necessary documentation and communication with your provider.
Will My Consultation Be Covered?
Some insurance plans cover your initial consultation if you’re seeking breast reduction for medical reasons. We encourage you to check with your insurer ahead of time, and our office staff can assist in determining what your plan allows.
Get Expert Support From a Trusted Team
Dr. Paul Watterson is board-certified and highly experienced in breast reduction surgery. He and his team provide not only surgical expertise, but also practical support for patients pursuing insurance coverage. If you’re ready to take the next step, contact Watterson Plastic Surgery at 801-571-2020 to schedule your consultation in the Salt Lake City area. We’ll help you understand your options, whether or not you qualify for insurance.
