What Do I Need to Do for BCBS of NJ PPO to Cover my Breast Reduction?

asked 1 year ago by shannonskinner in Las Vegas
Latest answer by Tom J. Pousti, MD
Question viewed 1,147 times
Tags: age 25-34, 5 ft 0 in to 5 ft 3 in, Blue Cross/Blue Shield, DD cup, insurance

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)

11 answers to What Do I Need to Do for BCBS of NJ PPO to Cover my Breast Reduction?

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... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

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.

David L. Abramson, MD
New York Plastic Surgeon

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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

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... more

Michelle Copeland, MD, DMD
New York Plastic Surgeon

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... more

Scott L. Replogle, MD
Denver Plastic Surgeon

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

Robert D. Goldstein, MD
Bronx Plastic Surgeon

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.

Steven Wallach, MD
Manhattan Plastic Surgeon

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... more

Hayley Brown MD
Henderson Plastic Surgeon

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.

John Whitt, MD
Louisville Plastic Surgeon

BCBS of NJ PPO to Cover my Reduction

See in person a provider plastic surgeon to evaluate, take photos, a history, etc SAo than the provider can write/ fax/ or e/mail the BCBS to obtain a predetermination approval before the operation. Best of luck from MIAMI.

Darryl J. Blinski, MD
Miami Plastic Surgeon

Breast reduction and health care plans

Your best way to find out is to start with a visit to a plastic surgeon in your network. They will examine you and correspond with the insurance company to se if they will cover it. Having documentation of previous physician and physical therapy appointments should provide additional support but each case is different. I wish you well. Dr Edwards