Insurance Coverage Requirements, Breast Reduction Surgery

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Insurance Coverage

Having an Insurance Company Cover the Cost of Breast Reduction Surgery

Getting your insurance company to cover anything these days can be quite a challenge. In order to get approval from insurance companies, a plastic surgeon, and the patient, must meet a certain criteria.

Criteria to Meet Insurance Companies Requirements

First, your plastic surgeon must estimate that he or she can remove at least 500 grams (one half to one pound) from each breast. Your surgeon must also show that you have disabling symptoms directly attributable to your large breasts, and your plastic surgeon must show that you have tried everything under your power to resolve the macromastia symptoms yourself. Along with this your plastic surgeon must provide photos documenting the need for this operation. Only then will there be a chance that surgery will be pre-authorized by your insurance company. And yet, the likelihood of insurance coverage for this problem remains small.

Further Requirements and a Catch-22

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.

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 insurance policy to find out).

Dr. Loftus performs many breast reductions, but does not accept insurance. Many women report that their deductible is higher than the cost of having the procedure performed by Dr. Loftus, and so, even though they have insurance, they find that they save by having it performed by a doctor who does not take insurance. Again, this is because the charges and deductibles are often higher when one goes through insurance.

Dr. Loftus

About Dr. Loftus

Dr. Loftus is a female plastic surgeon who is considered a national authority on plastic surgery, having appeared on numerous talk shows as an expert. Her book has become a best-selling book on plastic surgery and has earned her the reputation as a vocal advocate of patient safety, satisfaction, and education in plastic surgery. No wonder her patients have such great things to say about her…
Dr. Loftus standing by staff
My results are amazing - Dr. Loftus is amazing!
My friends can't believe how natural I look!
I had no pain after surgery and recovery was so easy.
The entire experience was fabulous!
I am a nurse who has worked with many doctors, Dr. Loftus is the best!
The care was exceptional and results are incredible!
My results are better than I ever imagined!
Dr. Loftus is a rare surgeon: highly skilled, personable and compassionate!
My experience from start to finish was completely extraordinary!
Awesome results from a skilled and caring doctor.
I love love love Dr. Loftus and everyone in the office!
I've never felt so comfortable and understood in a doctor's office.
I felt so comfortable and barely had any pain at all.
I never knew I could look this good! Thank you Dr. Loftus!!!
Never met such a warm and caring staff anywhere else.
If only every doctor could be like Dr. Loftus, how very fortunate we would be.

Dr. Loftus
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Dr. Loftus
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Dr. Loftus
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Dr. Loftus

Dr. Loftus
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Dr. Loftus
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Dr. Loftus
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Cincinnati: The Christ Hospital 2139 Auburn Avenue, Suite 201
Cincinnati, OH 45219
(513) 793-4000
5 minutes from downtown Cincinnati,
At the Christ Medical Office Building

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Northern Kentucky 1881 Dixie Highway, Suite 300
Fort Wright, KY 41011
3 minutes from downtown Cincinnati &
visible from I-71/75

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