Is Breast Reduction Covered by Insurance?
The Schnur Sliding Scale
Breast reduction can be considered medically necessary if it meets the criteria of your plan.
While each plan has its own criteria, for the most part, this begins with the amount of tissue to be removed. That determination starts with a BSA (Body Surface Area) calculation, based on height and weight.
BSA (m²) = √(Height (cm) x Weight (kg) / 3600)
Based on that result, there is a sliding scale (often called Schnur sliding scale) that determines the minimum amount of tissue to be removed for medically indicated procedures.
The Schnur scale has been used for decades, but in some cases, it has been revised to increase the requirement for removal. (see chart)
Once the tissue removal benchmark has been met, there are often other requirements for insurance approval. These can range from letters of medical necessity (from a practitioner other than the surgeon), to chart notes from physical therapists or chiropractors, to documentation from dermatologists or primary care physicians regarding chronic rashes or other skin conditions attributable to the size and pull of the breasts, and the side effects of the required bras.
To find out more about insurance coverage for breast reduction, or to find out whether we can work with your plan, please call us.
