Does Cigna Cover Breast Reduction?
- Cigna Medicare Advantage plans can cover breast reduction surgery in certain circumstances. Learn about the Cigna breast reduction eligibility requirements and who qualifies for coverage.
Some Cigna Healthcare Medicare Advantage (Medicare Part C) plans cover breast reduction surgery, so you should consult your policy documents to determine whether your plan includes it.
Medicare Advantage plans like the ones offered by Cigna Healthcare may not cover breast reduction in every situation, and you may have deductible or copay costs in addition to any plan premiums you may be responsible for paying.
Any Cigna Healthcare policy covering a qualifying mastectomy must also cover reconstructive surgery, as stipulated in the Women's Health and Cancer Rights Act (WHCRA) of 1998. Therefore, your plan will likely cover a breast reduction if you need it to create a symmetrical appearance following a covered mastectomy or lumpectomy.
When Is Breast Reduction Medically Necessary?
If your plan covers breast reduction surgery, you must meet Cigna Healthcare eligibility guidelines for breast reduction to receive coverage. To qualify, your surgery must be medically necessary. You must also be at least 18 years old at the time of surgery, or your breasts must have finished growing.
Cigna Healthcare considers breast reduction surgery medically necessary to treat macromastia, a condition where the breasts are disproportionately large. Cigna Healthcare only covers treatment if macromastia causes one of the following conditions and your symptoms don't respond to conservative treatment:
- Skin conditions, such as eczema or intertrigo around the breasts
- Ulnar nerve palsy with no other medical cause
- Shoulder, upper back or neck pain
Furthermore, Cigna Healthcare evaluates the amount of breast tissue requiring removal to determine whether a breast reduction is medically necessary. You may be eligible for coverage if the amount of breast tissue your surgeon plans to remove exceeds the 22nd percentile on the Schnur chart.
The Schnur chart compares the quantity of removed breast tissue to your body surface area. Alternatively, you may qualify if your surgeon intends to remove over 1 kilogram of tissue per breast, even if you don't meet the Schnur chart requirements.
Cigna Healthcare Breast Reduction Exclusions
Cigna Healthcare doesn't cover breast reduction surgery for cosmetic purposes, even if your policy covers breast reductions in general. Therefore, you won't qualify if the only reason you want a breast reduction is to improve the appearance of your breasts.
Cigna Healthcare Breast Reduction Requirements
Your doctor should submit medical evidence to qualify for breast reduction coverage through Cigna Healthcare. This evidence should include photographs demonstrating that you have macromastia. It should also include photographic evidence of shoulder grooving from bra straps or skin irritation if your doctor cites these as a reason for performing surgery.
Your doctor may also have to explain their rationale for recommending surgery and details of any conservative treatments you've tried to improve your condition. These may include weight loss, physical therapy, pain medications and supportive garments.
How Much Is a Breast Reduction?
According to the American Society of Plastic Surgeons, the average cost of breast reduction surgery without insurance is $7,800. However, this doesn't include the cost of additional services, such as anesthesia, so your total operative and post-operative expenses could be significantly higher.
Private healthcare insurance may cover some of these costs if your procedure is medically necessary.
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