Cigna PPO Breast Reduction Insurance Coverage

View Before and After Images of Breast Reduction in Los Angeles

Cigna PPO considers breast reduction surgery to be medically necessary in women over 18 years or if their breasts are done growing if the purpose of the operation is to improve symptoms caused by large breasts. Usually, symptoms include neck/upper back/shoulder pain. The symptoms should be present for an extended period of time and documented by a physician. Typically, patients need to try some type of medically supervised non-surgical treatment of these symptoms such as massages, support bras, physical therapy, or other non-surgical technique. Los Angeles plastic surgeon Dr. Elliot Hirsch performs breast reductions are both aesthetic and functional so that he will reduce the size of the breasts and the appearance will improve as well.

To schedule a consult with Dr. Hirsch, please call the office at 818-825-8131 or fill out our contact form.

Most Cigna 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.

To learn more about the procedure, visit our main Breast Reduction procedure page.
To view an overview of how different PPO plans handle breast reduction, see our Breast Reduction Insurance Coverage Guide.

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
Cigna Breast Reduction Insurance Coverage

What makes Cigna PPO insurance plans consider a breast reduction to be medically necessary?

Cigna PPO insurance plans may consider a breast reduction to be medically necessary if you meet the specifications described in above. In general, you must have large breasts that are causing health symptoms that are still present despite doing non-operate treatment for your symptoms under the care of a physician. 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 of you Cigna PPO breast reduction in Los Angeles.

How do you prove to insurance that you need a breast reduction?

In order for Cigna PPO to approve your breast reduction, Los Angeles plastic surgeon Dr. Elliot Hirsch and his team will submit an authorization request to your insurance company which will include the note from your consult and the procedure codes for your breast reduction. Cigna 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 Cigna PPO breast reduction cost if it is covered by insurance?

If your Cigna 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 Cigna Blue Cross PPO insurance, while a breast lift is not usually covered by insurance.

View Before and After Images of Breast Reduction in Los Angeles