Blue Shield 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 Blue Shield PPO insurance, patients must have large breasts that are causing symptoms like shoulder and/or neck pain or significant rashes that are caused by the large breasts. These symptoms are typically present for some period of time. Before undergoing a breast reduction, patients should try to help the pain using massages, support bras, acupuncture, weight loss, or other non-surgical way for at least 6 weeks.
- To learn more about the procedure itself, visit our Breast Reduction procedure page.
- For an overview of how PPO plans handle breast reduction, see our Breast Reduction Insurance Coverage Guide.
Blue shield PPO plans may also request that Dr. Hirsch estimate how much tissue he will remove during your breast reduction surgery in Los Angeles. This is based on a measurement called body surface area, or BSA. BSA relates to the amount of tissue to be removed in a measurement 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
Blue Shield Breast Reduction Insurance Coverage
What makes Blue Shield PPO consider a breast reduction to be medically necessary?
Blue Shield PPO insurance plans will usually consider a breast reduction to be medically necessary if you meet the criteria listed above. In general, you need to have large breasts that are causing symptoms such as neck pain or back pain or rashes for more that 3 months, you need to try some type of non-surgical treatment for these symptoms for at least 6 weeks, and the estimated amount of tissue to be removed should meet the chart shown above. Blue Shield may request additional documentation as well.
How do you prove to insurance that you need a breast reduction?
In order for Blue Shield to approve your breast reduction, Los Angeles plastic surgeon Dr. Elliot Hirsch and his team will submit an insurance authorization. This will include the note from your consult and the procedure codes for your breast reduction and additional documentation as necessary such as notes from physical therapy.
To schedule a consult with Dr. Hirsch, please call the office at 818-825-8131 or fill out our contact form.
How much does a breast reduction cost if it is covered by insurance?
If Blue Shield 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 Blue Shield PPO insurance, while a breast lift is not usually covered by insurance.
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