How to Get Bcbs of Illinois to Cover a Breast Reduction?

What percentage of bcbs of Illinois usely get approved? How long do you have to what if denied to appeal?

Doctor Answers (2)

Insurance coverage by BCBS

+1

Every insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX

Houston Plastic Surgeon
4.5 out of 5 stars 101 reviews

Breast Reduction and Insurance Coverage?

+1

I am not sure that the statistics that you are asking for our made available by insurance companies. The only way to know whether your breast reduction will be covered by specific insurance company will be to check with the insurance company. The first step would be consultation with  board-certified plastic surgeons to determine whether you are a good candidate for the procedure.

The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.

As you seem to understand, obtaining coverage for breast reduction surgery through an insurance plan may require persistence.  Ultimately it will likely be worth the effort; breast reduction surgery is one of the most patient pleasing operations we perform.

Best wishes.
 

Web reference: http://www.poustiplasticsurgery.com/Procedures/Procedure_breastReduction.htm

San Diego Plastic Surgeon
5.0 out of 5 stars 625 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.

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