Breast Reduction: Q&A
Ask a QuestionWhat Do I Need to Do for BCBS of NJ PPO to Cover my Breast Reduction?
I am 29 and 5"3 and weigh 140 lbs. I push out of a 34dd and would like to go down to a 34 full b/c. I have gone through two pregnancies/nursing and am now done. I have waited the 7 mo post nursing and have lost all the weight and then some. I have BCBS of NJ ppo and would like them to cover surgery as I cannot alone. I have documented with past ob/gyns the neck/back pain and headaches. Any words of advice to make this go smoothly with insurance. (live in NV with surgeons in ntwrk)
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12 Doctor Answers |
Asked by
shannonskinner
in Las Vegas
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Insurance coverage for Breast Reduction
Insurance coverage is a fickle thing. The only way to know for sure is to be evaluated by a plastic surgeon. At this time a pre-approval letter will be sent. The insurance company reviews the information and magically make a medical decision whether or not they intend to cover the procedure. It is not always a fair or just decision. From your description you seem to be a good candidate for the operation and would get symptomatic relief from your large breasts.
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Breast reduction insurance coverage
Based on your description you may be a good candidate for breast reduction surgery; for physical and emotional reasons.
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...
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Breast reduction
Horizon blue cross of new jersey is the most difficult plan to get authorization. You will need letters from two other physicians including an evaluation for back pain. Also notes from six months of conservative treatment like physical therapy.
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Breast reduction insurance coverage
Your best bet is to find a participating surgeon and go in for a consultation and have a predetermination of benefits letter composed to ascertain your level of coverage.
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Breast reduction insurance coverage
Breast reduction for large breasts is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine. Recently, managed care has adopted stricter standards for coverage, so these problems have to be thoroughly documented in writing by your primary care physician and plastic surgeon. They may also have to submit photographs. Even then, you may be required to seek a second...
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Breast reduction and insurance "coverage"
I recommend a different approach. Rather than depend on a government regulated insurance company or the government to "cover" you for a breast reduction procedure and determine whether you can have it, who you can go to, how much breast has to be removed, and what they will pay the surgeon and facility, I would think of it as a cosmetic procedure that you can choose all these things for yourself. It is possible to do breast reduction surgery under local anesthesia with IV...
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Insurence coverage for breast reduction
You need to establish medical necessity as defined by your plan. Your plan should be able to give you there criteria. Some guidelines are you need to be near normal body weight, symptoms of back, neck ,and shoulder pain that is not relieved with 6-9 months of therapy ( documented by an orthopedic surgeon or rehab doc ). Make sure your plan does not exclude this procedure. Good Luck
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Breast reduction and insurance
YOu would have to check with your insurance carrier to find out there requirements to cover a breast reduction. Each insurance company is different.
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Insurance coverage for Breast Reduction
If you have documented symptoms of back pain, neck pain, shoulder pain related to large breasts, insurance may cover your breast reduction. You need to see a plastic surgeon who is on your insurance plan for maximum benefit. During your consultation and exam, your doctor will let you know whether or not you are good candidate to have this done and be covered by insurance. A preauthorization from your insurance company, however, is no guarantee of payment, so be prepared for some...
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Insurance Coverage of Breast Reduction
With your 34DD+ bra size, body surface area, and history of neck/back pain, most insurance companies would cover a reduction taking you to B/C range. I do not recall dealing with BCBS (NJ) in the past, but some insurance companies will insist on PT, etc. I agree that your initial move should be to schedule an appointment with a BC plastic surgeon in your network who can then communicate directly with your ins. co.
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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