Medical Necessity for Breast Reduction

When it comes to breast reduction surgery the insurer or the insurance company, will want to know whether to pay for the surgery or not. There are a certain criteria that will be used by any insurer.

If the patient meets the criteria then the insurer will know that the surgery isn’t elective or for cosmetic purpose and as such, such person is eligible for the insurance coverage. One of such criteria is to have is to present with the medical bill claim a letter of necessity from the physician.

So a breast reduction letter of medical necessity is a narrative letter written by a physician on behalf of a patient stating why the patient medically needs a breast reduction. The letter will assure the insurer that the patient is really in need of the operation. It will show that the application is a genuine one since it will be coming from a qualified physician. The letter will explain why the patient needs a breast reduction and how it will medically help the patient. Another importance of this letter is to state why this operation is opted for and why other cheaper alternatives failed to help medically.

Also Read: Letter of Medical Necessity for Weight Loss Program

  Breast reduction letter of medical necessity is an official letter that should be professionally written either by a plastic surgeon or a primary care physician. This will help give the letter the power it deserves for a positive result. It will show that a bearer of the letter has a medical problem that need to be resolved and it isn’t just about seeking for a cosmetic breast reduction surgery. So at this point there are information that should be stated in the letter to convince the reader or recipient that there’s a need for the operation which will help improve the health of the patient. So the following information must be mention in the breast reduction letter of medical necessity

  • Name of the intended patient for the breast surgery operation
  • The name of the physician and the rank
  • There should be highlight on the history of sickness and how it is medically affecting the patient
  • The treatments and recommendations should be outlined
  • If possible the grams to be removed from each breast should be stated

Below are the sample breast reduction letters of medical necessity

Sample 1

4th August 2021

Re: Breast Reduction

Physician: Dr. Austin Black

To whom it may concern ,

A patient of mine,  Mrs.  Julia Dominic, for about 5 years has been suffering from chronic thoracic spine pain and a mid back pain which always make her experience severe neck strain and back pains. Though sometimes she respond positively to chiropractic treatment but the relief has always been for a very short time and the pains come up again which is a chronic mid back postural strain.

Naturally, someone that is diagnosed with this will respond positively to exercise strengthening routine for the core muscles and mid-back pains that was recommended but it isn’t working for Mrs. Julia. For the past 3 years she has been on an active and healthy regiment  which involves back strengthening  and mid-back muscles strengthening but still the there was been consistent counter balance  due to the midback muscles that the weight isn’t great for the breast.

On this note, Mrs. Julia will need a breast reduction operation and the recommendations are for medical necessity which will help resolve and alleviate this health condition for this patient. So please approve for her breast reduction surgery.

Thanks for your understanding and consideration

Yours sincerely,

Dr. Austin Black

Sample 2

Dr Amos Edwin

Big town hospital

Los Angeles

4th May 2004

To whom it may concern,

This letter is an appeal for a medical bill claim that will be send along with this letter by my patient, Mrs. Victoria James. A woman with symptomatic breast hypertrophy is plaque with serious signs which are related to the weight of excess breast volume. There should be a medical treatment like reduction mammaplasty that will help to resolve such condition to relieve all the health issues that comes with symptomatic breast hypertrophy.

We have tried with some conservative measures that were ineffective in relieving this issue permanently, as the issue always resurfaces in no time. Even non-surgical therapies that were recommended like exercise, physical therapy, use of support bras and medication were highly ineffective. so we are looking to give the patient a permanent relief of breast hypertrophy symptoms. So as examined and realized that Mrs. James is suffering from symptomatic breast hypertrophy we recommend reduction mammaplasty.

Reduction mammaplasty is a medically necessity operation that should be carried out to give a permanent relief to anyone having breast hypertrophy symptoms. I know that as a qualified doctor, I have the authority to recommend this operation as a medical necessity for my patient and that is what I’m doing with this letter which will benefit Mrs. James. Please approve this bill for the benefit of the patient.

Thank for you as you would consider this as well, because I know you always do.

Yours sincerely,

Dr Amos Edwin


If you have just received a denied coverage letter or you want to send one along with your medical bill claim for breast reduction, then you would need to contact one to write one out for you. With a letter of medical necessity it will be a lot easier to get your claim quickly approved. The insurer will want to know the medical need of having a breast reduction. The letter needs to be convincing enough which means having the right information that will appeal to them


The above guidelines will give you a clue on the information you should include in your letter. The samples have been written out as well. You can adopt any as a template. You just need to input your original information and you would have on your hands a well-written breast reduction letter of medical necessity.


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