Breast Reduction: Q&A
Ask a QuestionI Am 5'4" 110 and Have a 32dd Chest. Why Won't my Insurance Cover It?
My shoulders, neck and back are always hurting. I'm a petite woman and I can't afford thousands of dollars for a surgery. I don't understand why health insurance won't cover it. I understand why they wouldn't cover a breast enlargement, however, to reduce the size, it would benefit my health and well being. What am I supposed to do? I feel like I have no options.
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12 Doctor Answers |
Asked by
975917anon
in california
+2
Insurance Coverage for Breast Reduction
Insurance Coverage for Breast Reduction
Answer by George J. Beraka, MD
Manhattan Plastic Surgeon
80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.
1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.
2) Very big reductions (like from an F cup to a C cup)...
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Breast Reduction and Insurance Coverage?
Thank you for the question.
There is no way of an online consultant knowing why your breast reduction coverage was denied. Corresponding with the insurance company however may be helpful. It may be necessary to appeal the denial. Otherwise, it may be necessary to change your insurance plan.
Sometimes persistence pays off; continue to be a “squeaky wheel”.
Best wishes.
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Breast reduction
Every insurance company is different a d some plans specifically exclude breast reduction as a covered benefit. Other plans require a long period of physical therapy prior to approval.
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VIDEO ( breast reduction)
Schedule an appoointment with a plastic surgeon and have them compose a predetermination of benefits letter to your insurance carrier.
see video
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Insurance coverage of breast reduction
The short and nasty sounding answer is that you gave control of your health care needs to a third party and they now get to decide what you can and can't have. You can imagine how this might work with the federal government bureaucracy managing your other health care needs and decisions. If you asked an insurance company or the government to pay for your groceries you would run into the same thing in terms of what you want and feel you need and what they would let you have or pay for...
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Insurance and breast surgery
Each insurance company is a bit different when it comes to coverage for a reduction. You have to contact your insurance company with regards to their requirements.
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Insurance coverage for Breast Reduction
If you have documented symptoms such as back pain, neck pain, and shoulder pain from large breasts, sometimes insurance companies cover breast reduction surgery. It depends on your health insurance policy as well as findings from your doctors. I would ask your insurance company if it is a covered benefit and see a plastic surgeon on your plan.
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Breast reduction insurance coverage
In answer to your question:
My shoulders, neck and back are always hurting. I'm a petite woman and I can't afford thousands of dollars for a surgery. I don't understand why health insurance won't cover it. I understand why they wouldn't cover a breast enlargement, however, to reduce the size, it would benefit my health and well being. What am I supposed to do? I feel like I have no options.
Insurance companies do whatever they can to avoid their responsibility...
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Insurance Problem in Petite Women
Insurance coverage of breast reductions has long been diificult. I feel that petite women are at a disadvantage. Make certain that your insurance policy does not have an outright exclusion for reductions. If not, I have sometimes had success by involving state insurance commissioners.
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Insurance coverage of Breast Reduction - Don't give up!
Dealing with insurance companies can be a daunting and intimidating experience for the individual patient. This is an instance where your doctor needs to go to bat for you to obtain the necessary authorization.
It begins with a letter documenting typical symptoms of neck and back pain, rash under the breasts, occasional numbness of the small finger, and bra strap grooving. Some insurance companies want to see evidence of failed medical management (physical therapy and/or NSAIDS)...
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Los Gatos Plastic Surgeon
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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