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. Like seeing an orthopedic for the upper back pain, the dermatologist for the infra mammary dermatitis, the primary care doctor for pain relief, the chiropractor for adjustments. Get letters from all or as many as possible. This helps the insurance company determine the need for surgery.
4. Have the Plastic surgeon send a letter of pre determination with all the above info. and 3 views of photos (dated with your name on each photo). The PS should include ALL other documentation as I stated above (1 thru 3).
Finally, never give up! I had a patient argue for over 2 years to get coverage with her insurance. She finally was successful.
Best of Luck!
