My breast reduction was approved by Tricare. Doctor is charging me $3,500 for a breast lift and nipple reduction. Aren't breast lift and nipple reduction part of breast reduction? Should I pay extra? Should it be included? What should I do? Thank you.
Hi! If your surgeon is out of network, then he is free to charge you his usual fee. If your surgeon is in your plan, however, then he cannot charge you extra, because, as you say, lift and nipple reduction are integral parts of breast reduction and cannot be billed for separately.
Reducing the diameter of the areola and lifting the breast is all part of the procedure. There should be no extra fees for adding these. However sometimes, there would be an extra fee for the removal of tissue near the arm pit.
It all really depends on your insurance and the doctor. A breast reduction involves moving the nipple and lifting the breast by definition. If your surgeon is "in-network" for your insurance plan, then he is obligated to take whatever the insurance pays. However, if he is "out-of-network," then whatever the insurance covers just supplements his or her fee and your are responsible for the rest. It is entirely up to you if you want to go to an "in-network" surgeon or not. Keep in mind that even if the surgery is "covered" by insurance, the insurance company pays the surgeon considerably less than the market rate for the surgery. Good luck with your procedure.
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