BCBS Insurance Coverage for Breast Reduction and Panniculectomy?

Thank you for the question. It is possible that these procedures will be covered by your health insurance. You will need to submit as much supportive paperwork and pictures as possible and be prepared to be persistent. 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

It sounds like the rashes plus the pain from the osteoporosis that is being aggravated by your large breast size may make you a candidate for coverage. Visit http://www.drlomonaco.com/patient_resources.html and you can download an article called "Tips on getting Insurance Coverage"

Every insurance company is different. For your breast reduction, see your plastic surgeon for specific details about what is required to get this covered. Photos may need to be sent in and a certain amount of tissue may have to be removed. Concerning your panniculus, photos and preauthorization will most likely be required. Good luck!

No insurance will cover reduction surgery, breast or abdominal, on the basis that it will alleviate osteoporosis. The fact is, osteoporosis is not caused or worsened by large breasts or an abdominal pannus. Concentrate more on the pain and rashes in your quest for insurance coverage. There are several plans within BCBS, some of which may cover your procedures and some of which may not. Consult with a board certified plastic surgeon who can take photographs and pre-authorize/pre-certify... more

In general, BCBS is terrible about covering these procedures. On the other hand, most insurance companies hate to talk with patients. Give them a call. You will most likely speak with a nurse evaluator who will let you know how to proceed. If she gives you an option to see a physician, take it. See a qualified Plastic Surgeon and have them submit a letter for pre-authorization. If you follow the steps, you will know your out of pocket costs. Good Luck!

Insurance will sometimes cover breast reductions and pannus excisions for select conditions. For the breasts if there is documented symptoms and conservative treatment failure it may be possible. For the pannus, if there is a documented history of infections or rashes not amenable to conservative treatment, this may be covered

You should first schedule an appointment with a particpating provider and then discuss the planned procedure. If you are a candidate, then have the surgeon compose a predetermination of benefits letter to ascertain your elegibility for coverage.

Jessica, There is NO WAY to convince any insurance company of anything they they do not HAVE to do. They are only obliged to "cover" (which is NOT the same as "to pay") the items on your policy. IF your policy HAS a rider or "benefits" for breast reduction and for a panniculectomy - then - subject to meeting their criteria and finding a surgeon who will accept their payment - you can have these operations. If you policy does not have such benefits, you can try... more

Always check with your particular insurance company as to what their criteria are for coverage of these procedures. Any supporting evidence from other doctors is very helpful. If rejected follow the appeals process.

While it is certainly possible that your insurance might cover your surgeries, you do not provide enough information for anyone to determine that. Your weight might be an issue since some insurance companies demand that you be within a certian percentage of your ideal weight and if you failed lasp band surgery, you would probably not satisfy that requirement. However, your medical necessity might be established through other problems like rashes and ulcers. Consult with a board-certified... more