Breast Reduction: Q&A
Ask a QuestionWhy 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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16 Doctor Answers |
Asked by
mimijess
in miami,fl
+3
A breast reduction include a lift and areolar reduction
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 paid in full.
Many plastic surgeons actually don't take any insurance anymore and you would be asked to pay in full preop and try to get some reimbursement from your insurance after...
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+2
Get clarification from Doctor
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. Additional reduction of overly prominent nipples would not be included. As other surgeon's posts have mentioned, insurance reimbursement is much less than typical charges for the breast reduction procedure...
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+2
It all depends on the insurance.
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 insurance covers just supplements his or her fee and your are responsible for the rest. It is entirely up to you if you want to go to an "in-network" surgeon or not. Keep in mind...
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Insurance may only pay a part of your surgeon's fee.
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.
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Breast reduction is a fuzzy area...
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 with just liposuction without regard to shape, form, or aesthetics of the breast.
Breast lifts generally address the shape and form of the aesthetics of the breast. I do not know why...
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Combination of Noncosmetic and Cosmetic Procedures
Depending on your plan breast lift and nipple reduction may be deemed as cosmetic surgery procedures. Breast Lift and Nipple reduction are distinct procedures from breast reduction.
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Breast Reduction - Why is the Doctor Charging Extra if Breast Reduction is Covered?
Good question - and the answer may or may not be straight-forward.
Fist, in GENERAL, if you're using an in-network surgeon and the proposed procedure has been approved by the insurance company, then there should not be additional charges for you. A breast lift and nipple reduction (I'm assuming you mean a reduction of the areola) are typically part of a standard breast reduction. If, however, you are using a surgeon who does not participate in your insurance then he...
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Breast Reduction and Charges?
It will be most accurate if you ask your plastic surgeon's office about the specifics of billing; online consultants can only speculate.
Best wishes with your upcoming surgery.
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Insurance covers procedure but surgeon asks for payment
If your surgeon does not participate with Tricare, he may not recieve payment (you may get the check) therefore it is reasoanble for him/her to ask for payment in full pre-operatively. If he/she does participate, then itis likely that they will have to accept Tricare payments minus the obligated co-pay.
see video
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Breast reduction fees
Before your surgery carefully review all the expected fees for your breast reduction surgery. This can be a very confusing area when dealing with insurance. Every insurance policy is different and each has different requirements for the surgeon and patient as well. Make sure that you understand where each portion of the fee will cover.
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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