How to Get Documentation for Breast Reduction Insurance?

Yes, the more letters you have from physicians, physical therapists, and chiropractors etc. the better. It will behoove you to ask insurance company directly what their specific criteria are. 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

If you wish to have your breast reduction covered by your insurance company, start by calling them and asking them what information they need. Every company has different requirements. You will at least need a letter from your plastic surgeon requesting authorization for surgery, and a set of photographs (which your surgeon can take) for their review. Some insurance companies also want a letter from a chiropractor or orthopaedic surgeon documenting back, neck, or shoulder pain. Some... more

Karim, Insurance coverage for breast reduction surgery varies widely between no coverage at all and full coverage depending on the insurance carrier, the plan within the insurance carrier, the state you live in. Any documentation that you can provide to support your claim will improve your chances of getting coverage. That would include letters from family doctors, gynecologists and sometimes carriers even demand evaluation by an orthopedic surgeon. Good luck!

Hi, Insurance companies require specific documentation from plastic surgeons prior to approving reduction mammaplasty. This usually includes photographs demonstrating large breasts and shoulder grooving from bra straps, as well as a letter describing patient's symptoms, other treatment modalities attempted, and the estimated amount of tissue that will be removed. Supporting documentation from other physicians and health care professionals can be very helpful in facilitating the approval... more

 If you have symptomatic macromastia because of large breasts and this can be documented by your internist, orthopedist, or chiropractor, you may be able to get coverage.

Any time you go to see a doctor, they bill your insurance company. When they submit a bill they use a code to describe the reason for your visit. This gets logged into a database called the Medical Information Bureau (MIB). Soi if you make a breast reduction the main reason for your visit. It will automatically be filed under your insurance. You can also request that your physician(s) write a letter of support.

Most insurances require several things to cover breast reductions 1. Large breasts 2. Symptoms preferably documented by other healthcare providers, especially orthopedic doctors, chiropracters, physical therapists 3. Trials at non surgical treatment, proper bra support, physical therapy, etc 4. Removal of a certain amt of breast tissue (often based on the body mass index) If you are rejected and you feel you have all these bases covered follow the appeal process

Many ins. cos. want to see a failure of conservative therapy to approve breast reduction coverage. This may consist of physical therapy, chiropractic and/or orthopedic care, special bras, etc. Your plastic surgeon can usually document these failures as well as an estimate of the amt. of tissue to be removed in order for you to be approved for coverage.

This is a process that I suggest you get help with. Insurance companies often require several things before agreeing to cover a breast reduction. They may require: a letter from the plastic surgeon documenting the physical exam, how much weight will be removed and photographs; they may also require letters of "support" from orthopedic surgeons, neurologists, chiropractors, evidence of attempted weight loss, etc. I suggest you have a consultation with your board certified... more

Great question. Having done the insurance 'game' for over 30 years I can give you a footprint to follow: 1. Height and Weight issues. You should be near your "ideal" ht. vs wt. Meaning if 20 pounds over weight that is a reason to deny coverage. 2. The need to remove over 350 to 500+ grams of tissue per side. If your breasts do not meet this requirement than you either need a lift, mastopexy, or a denial from the insurance. 3. Have tried alternative treatments with documentation.... more

1. First you need to check if you insurance policy EVEN "covers" or has breast reduction "benefits". If it does not, you will have to pay out of pocket. 2. If it has such benefits, read the fine print and: a. Find out ALL their requirements for coverage (such as HOW LONG of a trial of conservative therapy: do you need a referral letter from a back "specialists" (such as a neurologist, neurosurgeon or even a chiropractor), How much breast weight needs to be taken... more

Hello, As I don't do any HMO work, I usually just send a letter to the insurer requesting pre-approval. If you have an HMO the process might be different. Insurers don't always make this very easy. I would ask your insurer directly to try to get the best answer.