Anthem PPO Breast Reduction Insurance Coverage
To schedule a consult with Dr. Hirsch, please call the office at 818-825-8131 or fill out our contact form.
For a breast reduction surgery to be covered by Anthem Blue Cross PPO insurance, patients must have large breasts that are causing symptoms such as neck/back pain or even rashes under the breasts. The symptoms should be present for an extended period of time. Patients need to have tried some type of medically supervised non-surgical treatment of these symptoms such as massages, support bras, acupuncture, weight loss, or other non-surgical technique. Usually, this needs to be supervised by their doctor over a time period of 3 months or more.
- If you’d like to learn more about the procedure itself, visit our main Breast Reduction procedure page.
- For an overview of how different PPO plans handle this surgery, see our Breast Reduction Insurance Coverage Guide.
Most Anthem PPO plans will also request that Dr. Hirsch estimate how much tissue he will remove during your breast reduction surgery in Los Angeles. This is based on your body surface area, or BSA, which is a calculation of your height and weight. This is called the Schnur scale, an example of which is below.
Schnur Scale
The Schnur scale is one way insurers estimate the minimum amount of breast
tissue that should be removed, based on body surface area (BSA). The table
below shows an excerpt of the scale used for these coverage evaluations.
View Schnur scale table
| Body surface area | Tissue to be removed (g) |
|---|---|
| 1.35 | 199 |
| 1.40 | 218 |
| 1.45 | 238 |
| 1.50 | 260 |
| 1.55 | 284 |
| 1.60 | 310 |
| 1.65 | 338 |
| 1.70 | 370 |
| 1.75 | 404 |
| 1.80 | 441 |
| 1.85 | 482 |
| 1.90 | 527 |
| 1.95 | 575 |
Frequently Asked Questions
Anthem Breast Reduction Insurance Coverage
What makes Anthem PPO insurance plans consider a breast reduction to be medically necessary?
Anthem PPO insurance plans may consider a breast reduction to be medically necessary if you meet the criteria listed above. Specifically, you must have large breasts that are causing symptoms. Before Anthem PPO insurance will authorize your breast reduction surgery in Los Angeles with Dr. Elliot Hirsch, you will need to try undergo some type of non-surgical treatment for these symptoms for a 3 months or so under the care of a physician. Also, the estimated amount of tissue to be removed should meet the criteria shown on the chart above. You may need to lose weight as well in order to qualify for insurance approval.
How do you prove to insurance that you need a breast reduction?
In order for Anthem Blue Cross to approve your breast reduction, Los Angeles plastic surgeon Dr. Elliot Hirsch and his team will submit an authorization. This will include the note from your consult and the procedure codes for your breast reduction. Anthem will occasionally request additional notes from your internal medicine doctor or primary care physician or other medical records.
To schedule a consult with Dr. Hirsch, please call the office at 818-825-8131 or fill out our contact form.
How much does an Anthem PPO breast reduction cost if it is covered by insurance?
If your Anthem PPO insurance covers your breast reduction, you are typically responsible for your in-network deductible and your in-network co-payment. Depending on the facility that is used for your surgery, Dr. Hirsch may be able to accept your insurance.
What is the difference between a breast lift and a breast reduction?
A breast reduction reduces the size of the breast and lifts/reshapes the breasts. A breast lift does not usually make a significant difference in size and only lifts/reshapes the breasts. A breast reduction can be covered by your Anthem Blue Cross PPO insurance, while a breast lift is not usually covered by insurance.
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