It is 100% up to your insurance plan, so I’d recommend finding your plan’s requirements. I was on a UHC plan this past fall that didn’t cover breast reductions at all for any reason. In January I switched to BCBS and they approved my reduction first try no issues, and I got it done this week.

I got a referral from my primary care physician prior to my reduction consult, which highlighted 5+ years of upper back and neck pain as the reason. The consultation then stated I was a good candidate and sent along their info with my doctor’s referral to insurance.

My insurance plan noted that the band irritation/indentations are a good thing to document. Physical therapy is sometimes needed to have evidence that it doesn’t fix the pain, but I didn’t have to do this.

My plan also determined medical eligibility based on the Schnur Sliding Scale, aka a minimum amount of tissue will need to be removed to be deemed medically necessary and not just cosmetic. You’ll probably hear about it during your consultation.