Documentation of Back Problems for Breast Reduction Insurance Coverage?

I appreciate the answers I got for my question about getting a breast reduction for my size H breasts and I have taken the advice from my answers. I have a consultation with a surgeon and I also have talked to my insurance company who says they cover with a PA. What would be advisable to do if they want documentation of my back problems and I can't go to a chiropractor because it's not covered by my insurance plan?

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11 Doctor Answers | Asked by Karim in Wood Cross Utah

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Documented back pain can support insurance claim for breast reduction

Back pain and strain is 'the' issue concerning the need for breast reduction and in the past was considered the primary indication for insurance coverage. Many insurance carriers rely on documentation of this finding in the predetermination process. The best documentation is from physical therapy, chiropractic therapy, or an evaluation note from an orthopedic or sports medicine physician. Documentation and support of the predetermination process can also come from your primary care... more

Doctor Recommendations help with insurance coverage

Insurance Criteria for Breast Reduction Varies between Companies but recommendations from your primary care doctor, your gynecologist and the Plastic Surgeon should be enough (the more the better) without having to go to a chiropractor. Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company. Contact your individual company and request their specific Criteria. Insurance company favors approval for patient with functional problems like the... more

Breast Reduction and Insurance Coverage?

Thank you for the question. Your primary care and/or psychologist may be helpful in documenting “back problems” and referring you to the appropriate spine specialists. These physicians will hopefully be covered through your insurance plan. Based on your description the hoops you are jumping through will be worth the trouble; breast reduction surgery is one of the most patient pleasing operations you perform. Best wishes.

Insurance coverage for breast reduction.

Insurance Coverage for Breast ReductionView Edit Answer by George J. Beraka, MDManhattan Plastic SurgeonContact the doctor80% 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... more

Breast Reduction

This can be done by your family practice or internist. You may also see physical therapist that can document this for you. This is important but what is most important is your height and weight to determine the body surface area which will determine how much breast tissue will need to be removed for this procedure to be deemed medically necessary. Good luck.

Documentation of back pain to support insurance coverage of breast reduction

Frequently your primary care physician or gynecologist are willing to write a course of physical therapy for management and treatment of back pain, This course of physical therapy will establish a record of back pain and the need for treatment.

Otto Joseph Placik, MD

33 reviews

Chicago Plastic Surgeon

Back pain documentation for breast reduction

If you can truly document back and neck pain this would be helpful. Care documented by an orthopedist for several months would be helpful. If the symptoms do not improve with exercises that they recommend or physical therapy, you may be able to get approval.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Back pain documentation

Since your insurance company is calling the shots it is best to find out from them what they mean by "documentation of back pain". It may be as simple as your plastic surgeon saying that you have back pain or as complex as an Orthopedic evaluation, scans and physical therapy.

Breast Reduction for Back Pain

It is unlikely that your ins. co. would require a chiropractive evaluation to document your back. Most ins. cos. want to see a failure of back pain correction with conservative measures (PT,etc.). Check with your ins.co. to see what their requirements are. Your family physician or an othopedist may be of help.

Insurance documentation varies

Hi Karim, Every insurance company will have different requirements for documentation. Make sure you have asked specifically what they want and have it in writing. The best place to start would be your regular family physician that is on your insurance plan. If you need more evaluation or documentation then he or she can refer you to another physician on the insurance plan. Best Wishes Dr. Peterson