I have always had large breasts, ever since age 14. I have recently realized they are probably what caused my poor posture,I am unable to sit/stand up straight for long periods of time with out slouching or having back pain. I have also been having lots of shoulder and upper back pain. My insurance uses the Schnur Sliding Scale, do you think I would be covered?
5'2", 140lb, 36DD - Am I a Candidate for Breast Reduction?
Doctor Answers (5)
Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.Best wishes,
Candidate for Reduction and Insurance coverage?
From your description, you will certainly benefit from a breast reduction. BUT I would definitely meet with a plastic surgeon and look at before and after to determine if you will be okay with the incisions. There are many issues to resolve and it is best done with both you and another family member present. Getting breast reduction covered under insurance is very difficult. In fact getting them to tell you, as the consumer, the number of grams needed to get coverage will be nearly impossible. I suspect in the end it will have to be paid out of pocket. The insurance frequently places the restrictions and makes it difficult without any medical substantiation. I have had many difficulties with my own patients (who truly needed it) getting coverage. The best way to get coverage is to call your insurance company (my patients really raised a stink)...remember you are the consumer and you are asking insurance to cover a procedure that your doctor deems is medically necessary.
Insurance Coverage for Breast Reduction Surgery
Thank you for your question.
Each insurance company differs with what they need to approve the breast reduction surgery. The only way to know if your insurance will cover this procedure is to visit with a board certified plastic surgeon and ask that they submit paperwork asking for authorization.
In my office, we send a letter as well as the chart notes and photographs of the patient. If you have any documentation from other doctors (chiropractors for back pain, general practitioner for rashes, etc.) it will be helpful to get letters and submit those letters along with the request for authorization.
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Candidate for breast reduction?
If your large breasts are causing problems with back pain and proper posture, you are a candidate for breast reduction surgery. Most plastic surgeons will do this either as a cosmetic procedure (you pay for it) or reconstructive, in which case the insurance pays. You should schedule a consultation with a plastic surgeon certified by the American Board of Plastic Surgery who will be able to help you determine whether your insurance policy will cover the surgery for you. Good luck.
Insurance candidates for breast reduction
In short you are a candidate for breast reduction, thouhg the issue for many is will insurance cover the cost? The Schnur scale was worked up in the 80's and is obsolete in our area. Insurance plans, even those that look similar are all different and we depend on a written predetermination of benfits to confirm coverage.
Web reference: http://www.peterejohnsonmd.com/breast-reduction
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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