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Paying for Breast Reduction Surgery
Insurance vs. Self-Pay
Getting Your Insurance Company to Cover the Cost
Of course, getting your insurance company to cover anything these days can be quite a challenge. Your best bet to getting a breast reduction surgery covered is to find a plastic surgeon who has a good track record with getting approval from insurance companies. If your plastic surgeon estimates that he or she can remove at least 500 grams (one half pound) from each breast, AND your plastic surgeon can show that you have disabling symptoms directly attributable to your large breasts, AND your plastic surgeon can show that you have tried everything under your power to resolve the macromastia symptoms yourself, AND your plastic surgeon can provide photos documenting the need for this operation, then there is a chance that surgery will be pre-authorized by your insurance company. Recently, however, meeting ALL of the above criteria has STILL not been enough. Most insurance companies now also require that the woman requesting this operation be at or near her ideal body weight. Unfortunately, this is where the catch-22 appears again: Women with macromastia are often unable to exercise because their large breasts are too cumbersome to allow it. So, they are unable to lose the weight necessary to satisfy the insurance company's requisites for pre-authorization. Dr. Loftus has found that when she includes in her letter to the insurance company the patient's prior history of macromastia during times of near ideal weight (if applicable), that this information verifies that IF the patient were able to lose weight, that she would still have macromastia and still be in need of the operation. You should ask your surgeon about including this information in your letter or pre-authorization (if applicable in your case). Of course, even though it may seem unfair that you and your surgeon are made to jump through such hoops, it is critical that both you and your surgeon include only honest information in your letter to the insurance company. Also, remember that even if your insurance company pays for the procedure and even if you use an in-network physician, you may still be responsible for a portion of the cost (check your policy to find out).
Many of you have inquired about whether Dr. Loftus still performs breast reductions. She does so, and this continues to be one of her most common procedures. She no longer accepts insurance, but is able to perform breast reduction as an out-of-pocket expense.
Self-Pay
If you do not have insurance, or if your insurance company denies coverage, you may pay for the procedure yourself (called out-of-pocket). Click here for the average cost of breast reduction in the United States, when performed as an out-of-pocket expense.
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