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Breast Reduction For JJ Cup With Federal Blue Cross Blue Shield PPO?

asked 7 months ago by LadySS in GA
Latest answer by Kelly Gallego, MD
Question viewed 230 times
Tags: Blue Cross/Blue Shield, candidate, coverage, shoulder pain

I've gone through two rounds of PT, anti-inflammation medication and muscle relaxers. My pcp bought up the idea of a breast reduction; however, I never followed up on her written referral. A year and a half later, the pain and shoulder grooving still exist and I have another referral. I have Federal BCBS PPO. I'm 240, 5'9, wear 36JJ and bottom heavy. My tummy is very flat and my waist fairly small. Even when I was 180, I still had the same cup size. Will my Insurance cover this?

7 answers to Breast Reduction For JJ Cup With Federal Blue Cross Blue Shield PPO?

+1

Breast reduction coverage

Patients with large breasts who also have persistent neck, back, and shoulder pain, shoulder grooving, and frequent rashes under the breasts tend to respond remarkably well to breast reduction. In fact close to 90,000 women benefit from these procedure each year. It can sometimes be challenging to prove medical necessity to an insurance company. The more documentation you can get from your pcp and physical therapist the better. The best judge as to... more
Kelly Gallego, MD

Sioux City Plastic Surgeon
+1

Insurance coverage for breast reduction

Not surprisingly. Your insurance company wants to avoid paying for your breast reduction surgery if they can. They often give several excuses despite your symptoms. Undergoing physical therapy is a waste of time. They may deny coverage based on your weight even though the surgery will still be needed if you lose weight. The key here is persistence. The insurance company is hoping you just give up trying. If you are indeed a good candidate for the... more
Ronald J. Edelson, MD

San Diego Plastic Surgeon
+1

Insurance Covering Breast Reduction

Sounds like you have covered most criteria that insurance companies require.In addition most will say a minimum of 500 grams of breast tissue needs to be removed from each breast and you would easily meet that. You should see a Board Certified Plastic Surgeon for an evaluation and to help you get pre-authorization. Insurance companies usually want documentation of what you have tried, such as a letter from your Physical Therapist and a letter from the doctor that prescribed your medications,... more
Miguel Delgado, Jr., MD

San Francisco Plastic Surgeon

www.dr-delgado.com

+1

A strong likelihood for coverage by insurance plan for breast reduction

From your explicit history, you stand an extremely high chance of being able to have insurance cover your breast reduction. You have failed conservative, non-operative therapy and hass massively enlarged breasts that would also qualify for coverage based on volume expected to be removed criteria. You should consult with a board certified plastic surgeon in your area who can examine you, explain his/her recommendations and then obtain authorization from your insurance plan. Some weight... more
Steven Turkeltaub, MD

Scottsdale Plastic Surgeon

www.turkeltaub.com

+1

You should definitely get insurance coverage for your breast reduction.

Insurance Coverage for Breast Reduction. I hope this article is useful. 80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points. 1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches. 2) Very big reductions (like from an F cup to a C cup) will... more
George J. Beraka, MD

Manhattan Plastic Surgeon
+1

Insurance coverage for JJ cup

Gigantomastia, with removal of over 1000 grams of tissue per breast, covered. You have had conservative management and it is a matter of your plastic surgeon submitting a detailed request for preauthorization to support the need for surgery. Best of luck.
Robert L. Kraft, MD

New York Plastic Surgeon

www.foresthillsplasticsurgery.com

+1

Breast Reduction and insurance coverage.

Thank you for the question. Based on your description you may be a good candidate for breast reduction surgery; it may be in your best interest to drop weight first. The ideal situation is for you to lose weight and be stable in regards to weight prior to surgery - that will give you the best chances of long-term results you will be happy with. If you, for example, have the surgery and then lose 20 more pounds, you may need to have another surgery... more
Tom J. Pousti, MD

San Diego Plastic Surgeon

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