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Breast Reduction and Insurance Coverage

Though breast reduction can be done for cosmetic reasons, in most cases women seek breast reductions for relief from health issues caused by excessively large breasts, such as shoulder and back pain.

If you are considering breast reduction, you should understand that your insurance may not cover the surgery. In particular, if you seek a breast reduction for purely cosmetic reasons, then insurance will not cover the costs of plastic surgery.

However, if you have a medical reason for breast reduction, then there is a chance insurance may pay for all or a portion of the costs. It is important to note that each insurer sets its own policies, so coverage varies from company to company. Even if your insurer covers breast reductions, you will be required to document the medical reasons for surgery.

Dr. Douglas Mackenzie and his team in Santa Barbara are well versed in navigating requirements for breast reduction insurance and can help document the medical reasons for surgery. Dr. Mackenzie is not contracted with your insurance provider, but will be considered an out-of-network provider if you have a PPO or similar plan.  If your insurance does not cover breast reductions, Dr. Mackenzie’s staff also can assist you by explaining financing options.

Your first step in determining insurance coverage for breast reduction surgery is to read your policy and talk with your insurance company. Insurance companies usually have criteria that need to be met before they will agree to pay for breast reduction surgery. Some common requirements include:

Even if you have insurance coverage for breast reduction surgery, you will want a clear understanding of what costs will and will not be paid by your insurer. For example, you will want to find out if liposuction in conjunction with breast reduction surgery is covered by your insurer. In addition, co-pays, deductibles, and uncovered costs can add up. Be sure you understand what costs you will be responsible for.

Financing Options

Not everyone has insurance that will cover breast reductions, so Pacific Plastic Surgery offers a number of patient financing options, including CareCredit. We also offer no-interest plans as well as extended payment plans for 24, 36, 48, and 60 months with fixed rates of interest.

If you need guidance on either insurance or financing options, please call our offices. We have trained staff knowledgeable about financing options and paperwork requirements.  Please contact us by calling 805-898-0700.


Douglas J. Mackenzie, MD

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