Is Breast Lift Surgery Ever Covered By Insurance?

Q: Dr. Eppley, I’m a 38DD and my breasts sag slightly. I have been treated for back pain for several years. My question is…is it difficult to get this procedure covered by insurance? I’m very interested in getting a breast lift but could not pay the entire bill out of pocket. Should I even try to pursue this?

A: To answer your question, the first thing to determine is whether you are trying to achieve a breast lift (with no reduction) or trying to get an actual breast reduction done. (smaller breasts with the lift that comes with them) Breast lifts are never going to be covered by insurance as that is a cosmetic procedure. Conversely many breast reductions are covered by insurance as they improve back, shoulder and neck pain as the size of the breasts are reduced.  Thus they are often viewed as medically necessary and may be covered. But their potential coverage has to be determined before surgery by a predetermination letter which documents your breast size, the symptoms associated with them and how much breast tissue will be surgically removed. From this information, the insurance company bases their decision for coverage.

But when it comes to  breast lifts, there is no purpose in trying to see if insurance will pay for it as that can be determined right now…there is no medical need and thus no insurance coverage for the operation.

Dr. Barry Eppley

Indianapolis, Indiana