Insurance Guide
Blue Cross Blue Shield plans often cover breast reduction and lift for patients with symptomatic macromastia, meaning large, heavy breasts that cause physical discomfort.
This guide explains how Blue Cross Blue Shield plans review breast reduction, how much breast tissue may need to be removed, and how we handle insurance preauthorization for breast reduction and lift at Kiwanuka Plastic Surgery in New York City.
Based on the Blue Cross Blue Shield Association reference policy 7.01.21. Each Blue plan sets its own policy, and your plan documents control.
Each Blue Cross Blue Shield company sets its own medical policy, and your home plan's policy applies. Many Blue plans base their criteria on the Blue Cross Blue Shield Association reference policy 7.01.21, Reduction Mammaplasty for Breast Related Symptoms, which asks for the following.
In New York, Empire BlueCross BlueShield now operates as Anthem, which uses its own guideline. Plans from other states follow their home plan's policy through the BlueCard program. We check which policy applies to you.
Under the reference policy, removal of at least 500 g per breast qualifies. Below that, the Schnur scale at the 22nd percentile sets the minimum for your body surface area. Your own Blue plan may differ.
Minimum tissue removal per breast under the reference policy. Our team checks your measurements against your own Blue plan's policy before your consultation. See the full Schnur scale and calculator.
Dr. Kiwanuka works with Blue Cross Blue Shield members through their out of network benefits. More than 95% of the insurance requests we submit are approved. Here is how the process works.
Our team
We check your plan's out of network benefits, deductible, coinsurance, and referral rules at no cost.
You and Dr. Kiwanuka
Dr. Kiwanuka examines you and plans your reduction. Consultations are complimentary for insurance patients.
Our team
Clinical photographs, records of prior treatment, and a letter of medical necessity written to Blue Cross Blue Shield's criteria.
Our team
We submit your request to Blue Cross Blue Shield and follow up until a decision is made.
All patients photographed with informed written consent. Individual results vary and are dependent on anatomy, procedure type, and recovery.
Often, yes. Blue Cross Blue Shield plans cover breast reduction when it is medically necessary: breasts large enough to cause physical symptoms that have not improved with treatment. Each Blue plan sets its own criteria, and your plan must include the benefit.
Your home plan's policy. Each Blue Cross Blue Shield company writes its own medical policy, and plans from other states follow their home plan's rules through the BlueCard program. We check which policy applies during your free insurance verification.
Yes. Empire BlueCross BlueShield is the Blue plan in New York and now operates as Anthem Blue Cross and Blue Shield. Read our Anthem guide for Anthem's breast reduction guideline.
Many Blue plans do. The Blue Cross Blue Shield Association reference policy uses 500 g per breast, or the Schnur scale at the 22nd percentile below that. You can estimate your number with our Schnur scale calculator.
Yes. Every breast reduction reshapes the breast and moves the nipple higher, so the lift is part of the operation. A lift on its own, without a reduction, is generally considered cosmetic.
Dr. Kiwanuka works with Blue Cross Blue Shield members through their out of network benefits. Benefits vary by plan, and our team checks yours for free before you schedule. You may request a written estimate of what we will bill at any time.
The reference policy asks for pain that has not improved with conservative care, such as a supportive bra, exercises, or heat and cold treatment. Your own Blue plan may set a specific period.
We review the reason and, when appropriate, send more documentation or an appeal. You also have appeal rights through Blue Cross Blue Shield, and some denials qualify for an independent external review.
Share a few details and our team will check your breast reduction benefits at no cost and with no obligation. Prefer to write? Contact us.
Verification confirms your benefits. It is not a guarantee of coverage or payment.