For many women, breast reduction surgery is not just about aesthetics—it’s about eliminating daily pain, regaining mobility, and living comfortably. But one of the most common questions we hear at Jandali Plastic Surgery in Trumbull, CT is:
“Will my insurance cover breast reduction surgery?”
The good news is: Yes, most insurance plans in Connecticut do cover breast reduction when it’s considered medically necessary. In this blog, we’ll explain how the process works, what insurers look for, and how our team helps you get approved.
What Insurance Plans Cover Breast Reduction in Connecticut?
We work with a wide range of commercial insurance plans, including:
- Aetna
- Anthem Blue Cross Blue Shield
- UnitedHealthcare
- Oxford
- Cigna
- ConnectiCare
Whether you’re in Bridgeport, Fairfield, Norwalk, Stamford, or New Haven, our office will verify your benefits and determine if your policy covers reduction mammoplasty.
When Is Breast Reduction Considered Medically Necessary?
Insurance companies consider breast reduction surgery medically necessary if you are experiencing physical symptoms related to large, heavy breasts, such as:
- Chronic neck, shoulder, or back pain
- Deep bra strap grooves in the shoulders
- Recurrent rashes or infections under the breasts
- Poor posture or skeletal alignment issues
- Difficulty exercising or performing daily activities
- Use of physical therapy, chiropractic care, or prescription medications for symptom relief
What Does the Approval Process Involve?
Here’s how the insurance process typically works:
Step 1: Consultation
Dr. Jandali or our Physician Assistant will perform a detailed examination, assess your symptoms, and determine whether breast reduction is appropriate for you. We’ll take photos and measurements as required by insurers.
Step 2: Letter of Medical Necessity
We’ll submit a comprehensive letter documenting:
- History and severity of symptoms
- Previous treatments you’ve tried
- Proposed amount of breast tissue to be removed
- Surgical plan and expected outcomes
Step 3: Prior Authorization
Your insurance company will review the materials and either:
- Approve the procedure
- Request more information
- Deny the request (we can appeal if needed)
This process can take 1–4 weeks, depending on your plan.
How Much Tissue Needs to Be Removed?
Most insurance companies use a formula based on your body surface area (BSA) to determine the minimum grams of tissue that must be removed from each breast to qualify.
At your consultation, Dr. Jandali will explain:
- How your measurements compare to your insurance’s requirements
- Whether your goals align with those guidelines
- If you qualify for full coverage
What If My Insurance Denies Coverage?
Don’t worry — denials are not always final. We frequently assist patients through the appeals process, which may involve:
- Submitting additional documentation
- A second opinion
- A peer-to-peer review with the insurance company’s medical director
Our experienced staff will walk you through every step and advocate for your care.
What If I Want to Pay Out of Pocket?
If your insurance doesn’t cover the procedure or you’d prefer to pay privately, we offer:
- Flat-rate pricing that includes surgeon fee, operating room fee, and anesthesia fee
- No surprise billing
- HSA/FSA card acceptance
- Financing options through third-party lenders
You’ll receive a detailed cost estimate during your consultation.
Insurance Coverage for Breast Reduction Across Fairfield County and Southern Connecticut
We help patients from across the region get insurance-covered breast reduction surgery, including residents of:
- Trumbull
- Bridgeport
- Stamford
- Fairfield
- Norwalk
- Milford
- New Haven
- Westport
- Shelton
- Monroe
- Stratford
- Greenwich
- Newtown
- Danbury
- Darien
- Wilton
- Easton
- Ridgefield
- Southport
Real Patient Results
Many of our patients report:
- Immediate relief of shoulder and neck pain
- Better posture and easier movement
- A boost in self-confidence
- The ability to exercise comfortably and wear desired clothing
Most patients say they wish they had done it sooner.
Take the First Step – We’ll Handle the Insurance
You shouldn’t have to live with constant discomfort and restrictions. Our team is here to guide you from consultation to insurance approval—and all the way through recovery.
Schedule Your Consultation Today
