Being a New York plastic surgeon’s office that caters to many public sector employees, we often are asked, “Does NYSHIP cover breast reduction surgery?” Many individuals with large breasts have suffered from neck and back pain for years and are surprised to learn that their insurance policy may offer a way to fix the issue. However, NYSHIP only covers breast reduction surgery in specific situations.
Below, we provide guidance on when this surgery is likely to be approved.
NYSHIP Does Cover Breast Reduction in Certain Scenarios
According to NYSHIP’s policy language, there are situations in which breast reduction surgery is considered medically necessary. Medically necessary is a subjective term mainly used to describe surgeries that are not purely aesthetic and correct functional or structural problems. They’re done because the patient suffers from chronic symptoms that cannot be resolved without surgery. To give you a better example, two scenarios are listed below. One scenario is an example of a surgery that NYSHIP would likely cover. The other is one where coverage probably wouldn’t be extended.
These two scenarios highlight classic motivations for breast reduction surgery as well as situations in which insurance considers it medically necessary. When it’s deemed medically necessary, the surgery will likely be covered, but like with most other medical treatments, it won’t be covered in full.
What Am I Responsible For?
If your surgery is approved because it’s considered medically necessary, that doesn’t mean you will escape all out-of-pocket costs. Your copay, coinsurance, and deductible costs will affect how much you pay for this surgery versus how much your insurance covers:
Bringing Patient Advocacy to Breast Reduction and Reconstruction
Harris Plastic Surgery works with NYSHIP and other insurance plans in covering breast reduction surgery for cases in which it’s medically necessary for patients. To find out more, contact us and schedule a consultation.
Joanne Parrinello, Practice Manager
Joanne Parrinello is an expert patient care coordinator, with two decades of experience navigating the complex financial side of medically necessary breast reduction and reconstruction surgery. She acts as a guide to patients, helping them understand their options and their expected out-of-pocket expense. The insurance industry can be complex and filled with jargon that makes you feel like you need a translator. At Harris Plastic Surgery, Joanne is that translator.