Commonly Asked Questions about Breast Reduction Surgery & Insurance Coverage

Will Insurance Cover my Breast Reduction Surgery?

In order for a breast reduction to be covered by your insurance, the insurance company must deem it to be “medically necessary.” This definition however varies from one insurance company to another and therefore is one of the most challenging procedures to get health insurance companies to cover. Our billing team at Ponte Vedra Plastic Surgery has years of experience navigating this challenge and is available to assist you.

What does Medically Necessary mean?

Most insurance companies require documentation that shows conservative measures have failed to relieve your back pain and discomfort. Conservative measure may include supportive undergarments, over-the-counter creams or medications for rashes, prescription pain medications, and even physical therapy. The most efficient way to assemble this information is to ask your provider, usually a Primary Care Physician, OB/GYN, or chiropractor, for a letter of medical necessity that outlines your symptoms, duration of tried and failed therapies, and his or her recommendation for breast reduction surgery.

What information will I need to provide?

When you call to schedule your consultation, we ask for your insurance information as well as current height and weight. Most insurance companies use a scale, sometimes referred to as the Schnurr scale, which uses your height and weight to determine the amount of breast tissue that needs to be removed for the surgery to be considered medically necessary. We will provide this information to your surgeon before your appointment along with the specific guidelines for your insurance. With that information in hand, your surgeon will perform an examination and be able to determine if sufficient breast tissue can be removed for insurance purposes and whether doing so will render the result you wish to achieve.

How long will it take to get a determination of coverage?

At your consultation we take photographs which we will send as part of a Precertification/Pre-Determination request. Some insurance companies can take 4-6 weeks to complete this review so be patient and know that our team is following your request and dealing with the insurance company on your behalf.

Once your surgery has been approved, you will get a phone call from our team to discuss what your patient responsibility will be. Since we bill for the surgeons and the Ambulatory Surgery Center, this helps to ensure no surprise bills after your surgery.


nicoleAuthored by:  
Nicole Jones, CPC – Revenue Cycle Manager

Could Breast Reduction Surgery Improve Your Life?

breast reduction jacksonville flWhile many women envy others with large breasts, large breasted women sometimes feel differently. There are some situations where bigger just isn’t better. When this is the case, breast reduction surgery may be a good option. Keep reading to learn more.

Who Is A Good Candidate For Breast Reduction?

Breast reduction isn’t for everyone, but for the right person, it can be an excellent solution. Ask yourself the following questions to determine whether or not you should consider the procedure:

  • Are you self-conscious about the size of your breasts?
  • Is the weight of your breasts causing your breasts to sag?
  • Does the size of your breasts make it difficult to find comfortable or flattering clothing?
  • Is it difficult to find bras in your size?
  • Do you have frequent back pain or neck pain?
  • Is the size of your breasts affecting your posture?
  • Are your breasts disproportional to the rest of your body?
  • Does the size of your breasts make it difficult to participate in physical activities that you’d otherwise enjoy?

If you answered yes to any of the above questions, you should consult your doctor about breast reduction.

What Can You Expect From The Procedure?

Breast reduction surgery is usually performed under general anesthesia, so you wont be uncomfortable or in pain during the procedure. The surgery usually takes two to four hours, but each patient is unique so each procedure will be a little different. In most cases breast reduction is performed as an outpatient surgery, but in some cases, it will involve a very short hospital stay. After the surgery, you’ll need to be patient as your body heals, but most people can return to work and other non-strenuous activities within about two weeks. Follow the instructions your doctor gives you to help your body heal as quickly as possible.

What Benefits Come With Breast Reduction?

Breast reduction can help you feel more confident, relieve back and neck pain, make it easier to shop for clothing, improve your appearance, make it easier to stay physically active, and more. If you’d like to learn more about this procedure, schedule a consultation at Ponte Vedra Plastic Surgery.