How to Get Documentation for Breast Reduction Insurance?

The more Physician recommendations for breast reduction the better - that would include your gynecologist, primary care doctor, plastic surgeon, chiropractor, etc.

Your plastic surgeon will then contact your insurance company for preauthorization. 

Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company. Contact your individual company and request their specific Criteria. Here is some general information however to help you :Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth).  In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities.  Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month.  Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance though insurance criteria are becoming more and more restrictive.

Thank you for your question.
Both your family physician and you gynecologist may have documentation of you having experienced rashes, pain, shoulder grooving as a result of large, heavy breasts. Give both a a call and have them forward records to the surgeon you are meeting with. Best wishes!

This procedure is commonly covered by insurance though insurance
criteria are becoming more and more restrictive. Although we do not accept
insurance, our staff will assist you in obtaining pre-authorization so that you
can attempt to be reimbursed for out of pocket expenses

Large breasts (macromastia) or breast hypertrophy can occur in a variety
of conditions (family trait, post pregnancy, excessive adolescent growth). In
general when the excessive breast size causes functional problems, insurance
will generally pay for the operation if more than 400 – 500 grams are removed
from each breast dependent on your individual insurance company requirements. This info needs to be in writing with photos sent for preauthorization

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 process. Letters from physical therapists and chiropractors documenting failed therapy for back pain and neck pain, as well as from primary care doctors demonstrating neck pain, shoulder pain and heat rashes despite appropriate use of a support bra, all help immensely.
Hope this helps. Best of luck.

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.

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,Dr. BasuHouston, TX

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.

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 also ask for a letter from a dermatologist if you have a rash beneath the breasts. But, before you spend a lot of time gathering letters, just call your company to see what their policy is. Good luck, /nsn.

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!

 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.