How to get documentation for insurance to cover breast reduction?

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 plastic surgeon.  In my office, we have an insurance consultant who works with the patient, guiding her throught the process and helping the patient obtain coverage.  This works very well.  Your local plastic surgeon's office can most likely help you with this.  Some people suggest the patient obtain these letters prior to meeting with their plastic surgeon.  I do not find this helpful as insurance requirements vary greatly and you could spend a lot of time doing things that end up being not productive.  Hope this helps.

Tracy M. Pfeifer, MD, MS

 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.

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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!

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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.

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