Hello mimijess,
Having your breast reduction "approved" does not mean the insurance company will pay the doctor. We have been in a situation where a major carrier "approved" a breast reduction. The patient loved the results, had complete improvement in symptoms and the carrier denied payment. Why? Arbitrarily they said we "did not remove enough" to cover it, even though the procedure was "approved" with photos ahead of time, all symptoms went away and she was thrilled.
The carrier may also pay only a small portion of what your doctor actually charges. He/she may charge $5000 for his fee and the carrier may say $1500 is what they pay. Some doctors have shortened the procedure if it is insurance related and they do only what is needed to relieve the symptoms of large breasts. They remove the tissue and cut off the nipple almost like a skin graft, thereby removing all sensation. It takes longer to do it while preserving nipple blood supply and nerve supply and that may be reflected in the fee.
I think the nipple reduction and lift is adding confusion to the situation. Go back to your surgeon and have him clarify. He/she is perfectly entitled to charge what he/she believes is a fair price for the service. Having insurance pay a portion makes it harder on the staff as they have to submit more paperwork and chase payment from the insurance company for up to one year after surgery.
In our office, we only offer breast reduction as a cosmetic procedure. We could not devote the enormous staff time that it took to pursue this procedure through an insurance company. The patient is free to pursue insurance payment themselves, but they tell us that the insurance company makes it as difficult for the patient as it did for our office when we tried to collect payment.
