Home Column Does Blue Cross Blue Shield Enshroud Breast Reduction?

Does Blue Cross Blue Shield Enshroud Breast Reduction?

by Dustin Cortright

Blue Cross Blue Shield breast reduction will cover your breast reduction in many cases, but only if you fulfill their criteria.

The criteria are the symptoms like back and neck pain, rashes under the breasts, and large breasts. You must know that if you have not had large enough breasts they will not approve the surgical operation.

At the examination your doctor, the surgeon will tell you about your breasts size, and if they are large enough for Blue Cross Blue Shield insurance. Insurance policies are different in the different states of the US.

You should make a meeting with a board certified plastic surgery for a consultation if you want Blue Cross Blue Shield to cover your breast reduction.

It is a common thought among the women that breast reduction is inexpensive and cosmetic reduction is expensive. This is no completely true because the costs are much closer than you think.

When you have a breast reduction you have to pay the bills from the hospital, anesthesiologists, supplies, and medications, also you must pay perioperative care and the surgeon. The same procedure as for the cosmetic reduction.

The best plan for you is to call your health insurance provider and find out what their criteria is because every insurance has their specific terms.

It also depends on the amount of tissue that needs to be removed on the operation, and you have some insurance policies that do not enshroud breast reductions at all.

Factors for evaluation in insurance companies for breast reduction surgery are: history of breast pain, neck-, back-, shoulder-pain, exercise, physical therapy; pain with exercise or interference with exercise; recommendation for breast reduction and documentation by physical therapist, primary care doctor, orthopedic surgeon or neurosurgeon; the amount of breast tissue removed at surgery.

If you want to know will insurance company cover the surgery you need to provide all the significant information about your condition? Are you having back pain, neck pain, shoulder pain, shoulder grooving, and if you get rashes underneath your breasts? Also, did you try other things for those symptoms?

Does Blue Cross Blue Shield Enshroud Breast Reduction?

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You can start with the evaluation of a plastic surgeon because he or she will know for sure if you are a suitable candidate for the surgery.

You must also know that even with the medical approvement the insurance company can deny it later if they find that “approval is not a guarantee of payment”.

To be sure if you are a candidate for this you can answer these questions down below. If your answers are yes to the most of these questions, there is a good chance that a good insurance plan will cover it.

  1. Have been to a doctor in the past 2 years about the large breasts and neck/shoulder/back pain?
  2. Have you ever had an infection or rash under your breasts?
  3. Have you ever been sent to physical therapy or a chiropractor?
  4. Do you take medications often for the pain?
  5. Have you ever had X-rays or an MRI of the neck or back?


Every company has a different set of rules for covering breast reduction, but they all look at the same factors, and you can include your doctor for primary care to help you with the procedure.

You need to also checks your height and weight as well because each the insurance company has their minimum number. Your plastic surgeon can calculate this number for you.

The best possible way is that your certified plastic surgeon write a letter to the insurance company. And when insurance company check your individual policy you will have the right information.

Before the breast reduction, some of the insurance companies require 3-6 months of treatment for neck and back pain.

Some of the Blue Cross Blue Shield rules are under 180 pounds, larger than a DD, and have tried conservative physical therapy for the back and shoulder pain.

Does Blue Cross Blue Shield Enshroud Breast Reduction?


Blue Cross/Blue Shield policies differ from state to state because every state has different requirements requiring coverage for breast reduction surgery. One of the best Blue Cross/Blue Shield is in Nebraska.

The procedure is something like this: your surgeon will then send a letter with your symptoms and the amount of weight he or she expects to remove from your breasts. You need to put a photograph of your breasts. This information is crucial for the determination of the insurance company.

Sometimes insurance wants to pay just for a part of reduction surgery if you have a lot of breast tissue for removal.

Blue Cross Blue Shield does cover breast reductions in consultation with your plastic surgeon. The little percentage of patients are rejected for this procedure, and you must be aware that this can be a very frustrating process.  

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