I am a size DD, and have had surgery on my cervical spine. I'm still having pain, I have Medicare; will it pay for a breast reduction?
Breast Reduction Medicare Coverage and Previous Surgery Pain
Doctor Answers (6)
Breast Reduction and Insurance Coverage?
Thank you for the question.
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 justifying the “medical necessity” of the operation.
This documentation and letter/pictures from your plastic surgeon will help you in the event that Medicare does not cover the procedure.
Make sure you're working with a well-trained/experienced board-certified plastic surgeon.
Insurance coverage for a breast reduction
You should first check with your insurance carrrier to determine what their cirteria are. Then see a plastic surgeon. You may also need notes from a treting physician for back pain and neck pain.
Insurance coverage for breast reduction
Breast reduction 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 opinion from a chiropractor, physical therapist, or orthopedic surgeon.
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Medicare payments for Breast Reduction
I agree with Dr. Placik. One of the frustrations with the IMMENSE bureaucracy of Medicare is that they will not tell the surgeon BEFORE surgery if they will or will not pay for a Breast reduction. In addition, although their fees for this procedure vary based on where you live, uniformly their fees are quite unreasonably low.
The prospect of not being paid and the certainty of being paid poorly for the operation makes it very hard for Plastic surgeons who must pay for their overheads to work with Medicare.
You may wish to go to www.PlasticSurgery.org and find which Plastic surgeons practice in your area. Contact their offices and see if they do Medicare Breast Reductions.
Breast reduction coverage with Medicare
The problem with medicare is that you cannot send a photograph or obtain any degree of predetermination of benefits prior to surgery which can be typically compl,eted with other insurance carriers. You can find a Medicare participating physician and discuss with them.
Medicare Breast Reduction
Coverage of breast reductions by Medicare gets a little "tricky". Medicare will not give prior approval for breast reduction or any other surgery, whereas most insurance companies will give you this answer. The criteria vary from state to state even though Medicare is a federal program. You should have a consultation with a BC plastic surgeon who can give you an opinion on whether or not your surgery would be covered.
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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