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the answer to is breast reduction surgery covered by health insurance? Can be very complicated and involve many variables. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. blog what makes breast reduction medically necessary? Posted march 09, 2017 in breast enhancement, breast reduction, chronic pain, insurance options, shoulder grooves. Breast reduction is unique among plastic surgery procedures because it is one of the few treatments that can be considered medically necessary. Schedule surgery! Once you are approved by your insurance to have a covered breast reduction operation, we can schedule your surgery. For most patients this operation takes a few hours, and many are able to go home the same day. also known as reduction mammaplasty, breast reduction surgery is a procedure that can be performed only via surgery, and only from a board-certified plastic surgeon. The procedure is meant for those who are seeking to reduce their breast size due to a number of reasons, the most common of which has to do with overly large breasts causing pain. Breast reduction is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine. Recently, managed care has adopted stricter standards for coverage, so these problems have to be thoroughly documented in writing by your primary. breast reduction surgery may be covered by the ontario health insurance plan (ohip), when it is being performed for medically necessary reasons. Breast reduction surgery is generally considered a reconstructive procedure and may be covered by private health insurance when it is performed to relieve medical symptoms. Many insurers define breast reduction surgery as reconstructive based on the amount of tissue that will be removed. breast reduction surgery will generally be construed as a cosmetic procedure unless the patient can prove that they have an underlying health condition that can only be remediated by undergoing the corrective procedure. Also, patients will have to meet a predetermined insurance threshold before the surgery can be covered by their insurance policy. If your breasts are disproportionately largeso much so that they cause medical concernsinsurance may cover surgery to reduce the size. The medical concerns in question include neck and back pain and skin infections. While that seems straightforward, you may still have to jump through a few extra hoops to get it covered. breast reduction surgery has been shown to boost self-esteem and quality of life for women with large breasts who may experience back or neck pain, skin.