Aetna 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 Aetna PPO insurance, patients must have large breasts that are causing symptoms neck and back pain and shoulder discomfort. The pain should be present for a period of time, and before undergoing a breast reduction, patients should try to help the pain using massages, support bras, acupuncture, weight loss, or other non-surgical way as supervised by a doctor for 3 months or longer. Women over 50 years of age need to have a mammogram within 2 years of their breast reduction surgery.
- 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 Aetna 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 Aetna PPO breast reduction evaluations.
View Schnur scale table
| Body surface area | Tissue to be removed (g) |
|---|---|
| 1.40 | 324 |
| 1.41 | 330 |
| 1.42 | 335 |
| 1.43 | 340 |
| 1.44 | 350 |
| 1.45 | 355 |
| 1.46 | 360 |
| 1.47 | 365 |
| 1.48 | 375 |
| 1.49 | 380 |
| 1.50 | 385 |
| 1.51 | 395 |
| 1.52 | 400 |
| 1.53 | 405 |
| 1.54 | 415 |
| 1.55 | 420 |
| 1.56 | 430 |
| 1.57 | 435 |
| 1.58 | 445 |
| 1.59 | 455 |
| 1.60 | 460 |
| 1.61 | 470 |
| 1.62 | 480 |
| 1.63 | 485 |
| 1.64 | 495 |
| 1.65 | 505 |
| 1.66 | 510 |
| 1.67 | 520 |
| 1.68 | 530 |
| 1.69 | 540 |
| 1.70 | 550 |
| 1.71 | 560 |
| 1.72 | 570 |
| 1.73 | 580 |
| 1.74 | 590 |
| 1.75 | 600 |
| 1.76 | 610 |
| 1.77 | 620 |
| 1.78 | 635 |
| 1.79 | 645 |
| 1.80 | 655 |
| 1.81 | 665 |
Frequently Asked Questions
Aetna Breast Reduction Insurance Coverage
What makes Aetna PPO insurance plans consider a breast reduction to be medically necessary?
Aetna PPO insurance plans may consider a breast reduction to be medically necessary if you have large breasts that are causing symptoms for an extended period of time. Before Aetna PPO insurance will authorize your breast reduction surgery in Los Angeles with Dr. Elliot Hirsch, you need to try some type of non-surgical treatment for these symptoms for a 3 months or so under the care of a physician, and the estimated amount of tissue to be removed should meet the chart shown above. You may need to lose weight as well in order to qualify for insurance approval.
How do you prove to Aetna PPO insurance that you need a breast reduction?
In order to get Aetna PPO to approve your breast reduction, Los Angeles plastic surgeon Dr. Elliot Hirsch and his team will submit an authorization through the online portal. This will include the note from your consult and the procedure codes for your breast reduction, as well as other documentation. 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 a breast reduction cost if it is covered by insurance?
If your Aetna 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 as well as lifts/reshapes the breasts. A breast lift does not usually make a significant decrease in size and only lifts/reshapes the breasts. A breast reduction can be covered by your Aetna PPO insurance, while a breast lift alone is not usually covered by insurance.
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