Breast Reduction Essex County, MA

Breast Reduction Essex County, MA – or reduction mammoplasty – frequently performed by Massachusetts surgeons. 98% of Breast Reduction patients posting on realself.com reported that the operation was worth it for them.

• What is Breast Reduction Surgery?
• How much does Breast Reduction Surgery cost if I pay out of pocket?
• Is Breast Reduction a Cosmetic Procedure or a Medical Necessity?
• What do Insurance Providers in Essex County say about Breast Reduction Surgery?
  • Blue Cross and Blue Shield of Massachusetts
  • Fallon Community Health Plan
  • Harvard Pilgrim Health Care, Inc.
  • MassHealth
  • Tufts Health Plan
  • UnitedHealthcare
• Office Directions from Essex County
• Newburyport Office Address
• Local Hospital Privileges

What is Breast Reduction Surgery?

Many women who develop a larger chest can become unhappy with their breasts.

Women consider breast reduction surgery for a variety of reasons and may have a number of goals, including to:

• Relieve physical discomfort associated with
  overly large breasts
• Proportionately balance their figure
• Refresh and improve your body contour.

Women with large breasts not only suffer from physical symptoms (also known as macromastia) including back, neck or shoulder pain, they may also have difficulty exercising, suffer low self-esteem and feel self conscious when out in public.

Breast reduction surgery in Essex County, MA aims to reduce the size, weight and shape of large and heavy breasts by removing excess breast tissue and fat, and reducing sagging skin to give the breasts an uplift at the same time.

The results are usually smaller, less painful and more manageable breasts with less chafing, along with a more youthful appearance.

Learn more about Breast Reduction Surgery by reading our blog on the most frequently asked questions.

How much does Breast Reduction Surgery cost if I pay out of pocket?

According to 2018 statistics from the American Society of Plastic Surgeons, the average cost for a breast reduction was $5680 but this doesn’t include fees for anesthesia, operating room facilities, or other related expenses, which can often double the cost.

Is Breast Reduction a Cosmetic Procedure or a Medical Necessity?

As with all surgery, it’s generally accepted that aesthetic surgery won’t be covered by health insurance but medically necessary surgery (for health reasons) may be covered.

As breast reduction surgeries are often performed because a patient can no longer bear the physical impact of having large breasts or that their daily life is affected, an insurance policy may cover some or all of the costs.

Patients should contact their insurance provider to find out what kind of written information they require from the surgeon when considering a claim – and to receive confirmation of how much of the procedure they will pay for. This needs to be established before surgery is booked.

We typically work with these insurance providers:

• Harvard Pilgrim Health Care
• Aetna
• CIGNA
• Blue Cross
• UnitedHealthcare
• Mass General Brigham Health Plan

What do Insurance Providers in Essex County say about Breast Reduction Surgery?

Blue Cross and Blue Shield of Massachusetts

In their Medical Policy for Reduction Mammaplasty for Breast-Related Symptoms, Blue Cross Blue Shield of Massachusetts state that breast reduction procedures may be considered medically necessary for the treatment of macromastia when specific clinical symptoms are present.

These symptoms may include a history of shoulder, neck or back pain that has not responded to therapy or relaxants, or intertrigo that is resistant to treatment.

They also suggest that a minimum of 500g per breast should be removed or that the plastic surgeon “must also follow the Schnur sliding scale, which suggests a minimum amount of breast tissue removed based on a patient’s body surface area”.

Learn more about Blue Cross and Blue Shield of Massachusetts and their Breast Reduction Procedure medical policies.

Fallon Community Health Plan

In their Cosmetic, Reconstructive and Restorative Services Clinical Coverage Criteria guidelines, FallonHealth states that Breast Reduction surgery “may be medically necessary to relieve a physical functional impairment caused by hypertrophic breasts”.

The typical candidate would also have “significant symptoms that have interfered with activities of daily living”. This may include persistent back and shoulder pain, arthritic changes, intertriginous maceration or shoulder grooving.

Like other insurance providers, for the breast reduction procedure to not be considered cosmetic, there is a minimal amount of breast tissue that should be removed.

Learn more about Fallon Community Health Plan and their Breast Reduction Procedure medical necessity guidelines.

Harvard Pilgrim Health Care, Inc.

In their policy on Cosmetic, Reconstructive and Restorative Procedures, Harvard Pilgrim Health Care writes that they cover reconstructive procedures “(i.e., surgery performed to improve function of a body part damaged or impaired by congenital defect, developmental abnormality, trauma, infection, tumor or disease) that are reasonable and medically necessary to improve or correct a physical functional impairment or remedy ongoing medical complications.”

They also state that they do not “cover most cosmetic procedures (i.e., surgery or treatment performed primarily to reshape or improve a patient’s appearance); such procedures are generally not considered medically necessary, even when intended to improve an individual’s emotional well-being or treat a mental health condition.”

Learn more about Harvard Pilgrim Health Care and their Breast Reduction Procedure medical necessity guidelines.

MassHealth

In their Guidelines for Medical Necessity Determination for Reduction Mammoplasty, MassHealth consider the principal candidates for breast reduction as “Women presenting various forms of breast hypertrophy (for example, macromastia or gigantomastia) accompanied by persistent clinical signs and symptoms that adversely affect health”.

When making a determination of medical necessity and coverage for patients, MassHealth will consider (among other things) back, neck or shoulder pain, or persistant intertrigo, that has been unresponsive to other treatments.

With MassHealth, reduction mammoplasty is not covered for normal-sized breasts, per the American Society of Plastic Surgeons definition. Reduction mammoplasty for surgically enhanced breasts or for reductions of less than 300 grams are also not covered.

Learn more about MassHealth and their Breast Reduction Procedure medical necessity guidelines.

Tufts Health Plan

In their Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery, TUFTS state that “reconstructive surgery and procedures are covered when the services are necessary to relieve pain or restore a bodily function that is impaired as a function of congenital defect, birth abnormality, traumatic injury or covered surgical procedure.”

Like other providers, TUFTS do no cover any types of cosmetic surgery or procedures. They defined cosmetic as “to change or improve appearance”.

Learn more about TUFTS Health Plan and their Breast Reduction Procedure medical necessity guidelines.

UnitedHealthcare

For women suffering from macromastia, UnitedHealthcare will consider covering Breast Reduction Surgery when the patient’s has functional impairment(s). This may include, but is not limited to, headaches, intertrigo, shoulder grooving, and other pain and restrictions to physical activities.

UnitedHealthcare will not consider coverage for Breast Reduction surgery when the procedure is performed only to improve cosmetic appearance without improving a functional impairment.

UnitedHealthcare defines Functional Impairment as: “Functional/Physical or Physiological Impairment causes deviation from the normal function of a tissue or organ. This results in a significantly limited, impaired, or delayed capacity to move, coordinate actions, or perform physical activities and is exhibited by difficulties in one or more of the following areas: physical and motor tasks; independent movement; performing basic life functions.”

Learn more about United Healthcare and their Breast Reduction Procedure medical necessity guidelines.

Local Hospital Privileges