BCBS Denied Me 2x for Breast Reduction? What Else Do They Need?

BCBS denied me, I appealed, they just denied me again. This time the reason is, "Your medical records fail to prove that this is the best treatment to stop your neck and shoulder pain." What are they needing now? I am getting so fustrated with them. I am 5"7 145lbs and I have 36DDD. If there is any info that could help me, that would be awesome!! Also, looking for a board certified p.s in the austin area that will help me get this done w/ insurance. The PS I saw in Temple wasn't helpful.

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11 Doctor Answers | Asked by white5722

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Insurance Coverage for Breast Reduction

If you are as big as you claim to be then a plastic surgeon should have little trouble convincing an ethical insurance company of the benefits of breast reduction. Generally patients who have all or part of their surgery covered have chronic back, neck, and/or shoulder pain. They may have exercise intolerance as well. Physical exam could exam could show shoulder grooves, and even scarring or variations in pigmentation. A history of pain related problems helps but it is not always necessary.... more

Getting Insurance Coverage for Breast Reduction

Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company. In your case: The more Physician recommendations for breast reduction the better - that would include your gynecologist, primary care doctor, plastic surgeon, chiropractor, etc.They want to see that you have already tried non surgical means such as weight loss, physical therapy, chiropractic treatments, etc but still have problems..Contact your individual company and request their... more

Insurance coverage for Breast Reduction surgery

Documentation, documentation, documentation! It is often helpful to have as many specialists recommend in writing your surgery, ie; pain specialist, orthopedist, spine surgeon, primary Dr., OB-Gyn, etc. The more the better! Even if you have these, you may still get denied. Do yourself a favor and call your carrier directly and find out how many grams are required to be removed for coverage. You may not be happy to hear that the amount they require may leave you too small. If this is the... more

Second denial for breast reduction

Ok. They want proof that the reduction will alleviate th back and shoulder pain. While we know that breast reduction will accomplish this, what they are saying indirectly is to find a cheaper, non-invasive way first and then show us that it didn't work. Check the BC website for your carrier and find criteria for coverage on line. Try may require 6 months of chiropractic or physical therapy. Fulfill this requirement per the guidelines and then reapply for preauthorization. The second level... more

Insurancena nd breast reductions

Welcome to the world of medical insurance! Jumping through hoops is part of their game.,e venthough you may be a very good candidate for surgery. When all else fails, you may wnat to consider self-paying.

Steven Wallach, MD

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Manhattan Plastic Surgeon

Insurance coverage for breast reduction

Each insurance company has different criteria that it uses to determine medical necessity. Your plastic surgeon may be able to get these criteria which you can then use to document your need. In addition, policies even with the same insurance company can vary. So it may take a bit to determine what criteria you need to meet. This can be very frustrating but just be aware that this is fairly standard procedure for insurance authorizations; most, if not all, of us who do breast reduction... more

BSBC

Didn't their initials give you a hint? BS BS BS BS You are wasting your time and the time of any surgeon that trys to help you in this hopeless endevour. Insurance companies have been allowed to defraud their cusomers and that means you. You need to save your pennies until you have $7,172 (the total cost for breast reduction at Lake Tahoe Plastic Surgery) use a credit card or apply for credit with Care Credit or Chase Health Advance. We help patients if they... more

BCBS Denied Me

They look for things like weight loss (not an issue for you) and a reasonable time trying nonsurgical methods of back and neck pain relief. Often notes from a physical therapist, orthopedist or chiropractor will help. Then have your plastic surgeon send in a not with estimates of the breast weight he expects to remove.This is a stalling technique all insurance companies use to try and avoid payhing out claims. They hope you will go away. Have an attorney write a letter and tell Blue Cross he... more

BCBS and Breast Reduction

Insurance companies are generally making even clearly medically necessary procedures more difficult to be covered. Persistance and documentation from physicians other than you surgeon generally are needed. In regards to finding a surgeon, the American Society of Plastic Surgery and the Aesthetic Society of Plastic Surgery can provide you lists of qualified, board certified plastic surgeons. Consult with 3 - 4 experienced and expert board certified plastic surgeons who are in your... more

Breast reduction with insurance

Most insurances will cover breast reduction surgery with the proper documentation. If you are having back, neck, and/or shoulder pain due to large breasts, shoulder grooving at the bra straps, or recurrent skin rashes you are a good candidate. You should have documentation of failure of pain control with antiinflamatories and/or physical therapy. X-rays are sometimes required. Look for a surgeon that performs this procedure routinely, which translates into getting his patients approved. From... more