Introduction
For many women in Connecticut, breast reduction isn’t just about aesthetics — it’s about relieving daily pain, improving posture, and restoring mobility. The good news? If your large breasts are causing documented medical symptoms, your breast reduction may be covered by health insurance.
At Jandali Plastic Surgery in Trumbull, we’ve helped countless patients from Bridgeport, Fairfield, Stratford, Milford, Shelton, Westport, Norwalk, Easton, Monroe, Derby, Ansonia, Seymour, Oxford, Newtown, Bethel, Weston, Wilton, and Southbury navigate the insurance process successfully.
Patient Testimonial (Bridgeport):
“I thought I’d be paying out of pocket. Dr. Jandali’s office handled everything, and I was approved in just four weeks.” — Jenna, Bridgeport
Visit our Before and After Breast Reduction Gallery
Why Insurance Covers Breast Reduction
Breast reduction is considered medically necessary when large breasts cause:
- Chronic neck, shoulder, and back pain
- Shoulder strap grooves with skin indentation
- Rashes or skin breakdown under the breasts (intertrigo)
- Tingling or numbness in the arms from nerve compression
- Posture-related headaches or upper body discomfort
- Difficulty with physical activity or daily tasks
When symptoms persist despite conservative treatments (special bras, physical therapy, medication), surgery often meets medical necessity criteria.
Step-by-Step: How to Get Approved
1. Verify Your Coverage
Before scheduling surgery, call your insurance provider. Ask:
- “Does my plan cover CPT code 19318 (reduction mammaplasty) when medically necessary?” Some plans have exclusions that don’t cover breast reduction surgery unless it is related to breast reconstruction after a breast cancer diagnosis.
Pro Tip: Write down the representative’s name, date, and call reference number.
2. Clinical Evaluation
Your first appointment with us includes:
- Detailed symptom history
- Physical exam and breast measurements
- Review of prior conservative treatments
- Photos (confidential, for insurance purposes)
- Estimate of breast tissue to be removed (grams per breast)
3. Letter of Medical Necessity
We draft a customized letter that includes:
- Your diagnosis (e.g., macromastia or gigantomastia)
- Duration and severity of symptoms
- Failed conservative treatments
- Measured breast size and ptosis
- Estimated tissue removal amount
- Statement of expected benefits from surgery
4. Supporting Documentation
We include:
- Office visit notes from primary care or specialists (ObGyn, back surgeon)
- Physical therapy notes (if applicable)
- Dermatology notes for skin issues
- Photos showing shoulder grooves or rashes
5. Complete Insurance Packet Submission
Our insurance coordinator compiles:
- Letter of medical necessity
- Photos
- Medical records
- Preauthorization form
This one complete submission reduces delays from piecemeal requests.
6. Insurance Review Period
Typical timelines:
- Standard review: 2–6 weeks
We follow up weekly to check status.
If You’re Denied: How Appeals Work
Even in Connecticut, denials happen — often due to:
- Missing documentation or photos
- Disagreement on medical necessity
- Not meeting minimum tissue removal requirements
Our Appeal Process:
- Review denial letter for specific reasons
- Gather additional documentation or specialist letters
- Submit an appeal letter addressing each point
- Request peer-to-peer review between Dr. Jandali and the insurance medical director
Patient Testimonial (Monroe):
“My initial request was denied because they claimed I didn’t meet the weight removal requirement. Dr. Jandali appealed and won.” — Laura, Monroe
Network Gap Exceptions
If your plan covers the procedure but requires in-network care — and no local in-network surgeon is available — we can request a network gap exception to allow in-network benefits at our practice.
Common Insurance Carriers Covering Breast Reduction in CT
- Anthem Blue Cross Blue Shield
- Aetna
- Cigna
- UnitedHealthcare
- Harvard Pilgrim Health Care
- ConnectiCare
Typical Medical Necessity Criteria
While each plan varies, common requirements include:
- Documented pain in two or more body areas for at least 6 months
- Failure of at least 3 months of conservative treatment
- Tissue removal estimate meeting insurer’s threshold
- Photographic evidence of physical effects
Out-of-Pocket Costs
- You will only owe whatever your in-network deductible and co-insurance are.
Local Advantage: Easier Paperwork & Follow-Up
Patients from Fairfield, Bridgeport, Milford, and Shelton find our location ideal for:
- Preauthorization visits
- Document collection
- Post-op check-ins
Internal Links for the Series
Contact Us
If you’ve been living with pain or discomfort from large breasts, let us help you navigate insurance coverage. We handle every step — from benefit verification to appeals — so you can focus on your health.
Jandali Plastic Surgery
5520 Park Ave, Suite WP-2-300, Trumbull, CT 06611
Phone: (203) 374-0310 | Website: jandaliplasticsurgery.co
