Documentation of Back Problems for Breast Reduction Insurance Coverage?

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

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 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

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.

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.

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.

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.

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.

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

Why not see a MEDICAL back specialist (Orthopedic or Neurosurgery) who may even be on your insurance panel? If they are not OR if your insurance company insists on a chiropractor, PAY HIM OUT OF POCKET (the way you would pay when you take your dog to the vet, pay your electrician, plumber etc) . I assure you that whatever the chiropractor may charge you would be much cheaper than if you had to pay the cost of your justifiable Breast Reduction.