Why is the doctor charging extra if breast reduction is covered?

My breast reduction was approved by Tricare. Doctor is charging me $3,500 for a breast lift and nipple reduction. Aren't breast lift and nipple reduction part of breast reduction? Should I pay extra? Should it be included? What should I do? Thank you.

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9 answers to “Why is the doctor charging extra if...”

A: Breast Reduction and Insurance coverage

By Michael A. Bogdan, MD - Dallas Plastic Surgeon

A breast reduction is one of the most labor intensive procedures that plastic surgeons perform, and it takes a significant amount of time (both in the operating room and for aftercare visits) to do correctly. Insurance reimbursement is not consistent with the amount of work involved, and with some... more

A: A breast reduction include a lift and areolar reduction

By Richard P. Rand, MD - Seattle Plastic Surgeon

Reducing the areola and lifting the breast are part of a breast reduction. You should discuss the charges with your surgeon and ask for clarification. Please understand that the amount the insurance will pay the doctor is a tiny fraction of the bill so don't be mislead by believing that the doctor is being... more

A: Get clarification from Doctor

By Sutton Graham II, MD - Greenville Plastic Surgeon

Mimijess: In general, insurance or self-pay breast reduction includes removal of excess skin, fat and breast tissue. The areola (not the actual nipple) is lifted and repositioned as part of the procedure. Additional liposuction of the lateral chest is not included, but often helpful. ... more

A: It all depends on the insurance.

By David Shafer, MD - Manhattan Plastic Surgeon

It all really depends on your insurance and the doctor. A breast reduction involves moving the nipple and lifting the breast by definition. If your surgeon is "in-network" for your insurance plan, then he is obligated to take whatever the insurance pays. However, if he is "out-of-network," then whatever the... more

A: Breast reduction includes lift and areola reduction

By Sirish Maddali, MD - Bay Area Plastic Surgeon

Breast reduction includes a breast lift and reducing the size of the areola NOT the nipple. If your nipples are also being reduced, then that can be billed separately. However, if you have an HMO and your doctor is on your plan, then your doctor has to accept payment from the insurance company for a breast... more

A: Insurance may only pay a part of your surgeon's fee.

By George J. Beraka, MD - Manhattan Plastic Surgeon

Hi! If your surgeon is out of network, then he is free to charge you his usual fee. If your surgeon is in your plan, however, then he cannot charge you extra, because, as you say, lift and nipple reduction are integral parts of breast reduction and cannot be billed for separately.

A: Discuss the fees with the doctor so you are fully aware

By Francisco Canales, MD - Sonoma Valley Plastic Surgeon

Hello mimijess, Having your breast reduction "approved" does not mean the insurance company will pay the doctor. We have been in a situation where a major carrier "approved" a breast reduction. The patient loved the results, had complete improvement in symptoms and the carrier denied... more

A: Breast reduction is a fuzzy area...

By Robin T.W. Yuan, MD - Beverly Hills Plastic Surgeon

There are a multitude of procedures referred to as breast reduction, including simple liposuction. Some involve long scars and some short. From an insurance point of view, the only real concern is relief of the weight of the breast producing neck, back, or shoulder strain. This can potentially be accomplished... more

A: These are part of the procedure

By Robert D. Goldstein, MD - Bronx Plastic Surgeon

Reducing the diameter of the areola and lifting the breast is all part of the procedure. There should be no extra fees for adding these. However sometimes, there would be an extra fee for the removal of tissue near the arm pit.