How to Convince Insurance to Cover Breast Reduction?

I am 20 years old and I have 38DD breasts. I would love to get a breast reduction because as long as I can remember I have had back, neck and knee problems. I have horrible posture and running and exercising is difficult because my breasts get in the way. I can't afford it myself so I was wondering how to prove to your insurance that my large breasts are causing my pain? Thank you for your time.

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age 18-24 back breasts knees DD cup pain female insurance

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11 Doctor Answers | Asked by kdaniels39 in Redding, CA

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Criteria for Insurance Approval of Breast Reduction

Insurance company favors approval for patient with functional problems like the ones you mentioned - back, neck and knee problems, bad posture, inability to run , etc. Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company. Contact your individual company and request their specific Criteria. The more Physician recommendations for breast reduction the better - that would include your gynecologist, primary care doctor, plastic surgeon,... more

Insurance Coverage for Breast Reduction Surgery

Insurance coverage for breast reduction surgery varies from company to company and requires that you meet certain criteria. These include documentation of neck and back pain, documentation of physical therapy for the neck and back pain, an insurance-specified anticipated minimum amount of breast tissue removal, and photographs. This information will need to be submitted to the insurance company by the plastic surgeon's office for authorization to cover the breast... more

Insurance coverage for breast reduction

My staff is expert at dealing with insurance carriers and it is not a matter of being convincing. Each insurer has its own set of criteria, which change regularly and what is essential is to know and understand the rules and then be willing to jump through the hoops. They are continuously making it more challenging. It is also important that your plastic surgeon provide all supporting information required and to be prepared to appeal on your behalf, based on the peer reviewed literature. ... more

Breast reduction insurance coverage

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 letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you're saying a well-trained/experienced... more

Breast Reduction and Insurance Coverage

Dear kdaniels39, Each insurance company is different and, not surprisingly, it is become harder and harder to get insurance companies to pay for this procedure. In general, though, they will cover the procedure if you can show that removing the indicated amount of tissue (more on that below) will be likely to alleviate certain specific symptoms. First, then, you have to have those symptoms. Typically they would include neck, back and shoulder pain, bra strap grooving... more

Insurance coverage for breast reduction.

Insurance Coverage for Breast Reduction Answer by George J. Beraka, MDManhattan Plastic Surgeon80% 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 usually be... more

Insurance and breast reductions

Every insurance company is different, and they are trying to make it really difficult to get approval. Usually if you can document the symptoms from doctor's notes and your of a certain height and weight combined with a large breast size, then approval is usually easy.

Steven Wallach, MD

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Manhattan Plastic Surgeon

Breast Reduction Under Insurance

They look as several factors when they try to decide if the patient will be covered under the health insurance coverage for breast reduction. They look at your symptoms in addition to your height and weight, breast size and the amount to be removed. They have a formula that is based on your height and weight and that will determine how much they will want to have removed in order to cover the surgery. I have had good success getting breast reduction covered by the patient health insurance... more

Breast Reduction Insurance Coverage

Insurance companies look at your symtoms, your body surface area, and the estimated weight of tissue to be removed when making a determination of whether or not to cover breast reduction surgery. If you are willing to have a C-cup postop, your procedure would probably be covered by most insurance companies.

Insurance coverage for breast reduction

If you have documented symptoms of back pain, neck pain, shoulder pain, severe grooving from your bra straps, or rashes, your insurance carrier may cover a reduction mammaplasty. Before you start the process, you should check with your insurance carrier to ensure that you don't have a policy which excludes coverage for for breast reduction and to see if your insurance company requires a regimen of physical therapy prior to covering the procedure. Your insurance carrier may also mandate... more

Breast Reduction and Insurance Coverage

The best way to start is with a consultation with a board certified plastic surgeon. Look for a member of ASAPS or ASPS. Different insurance carries have different criteria for coverage. Your height and weight may be used to calculate your Body Mass Index(BMI). If your are in the overweight category you may be asked to loose weight. Sometimes documentation of your symptoms and failure of treatment with non-surgical options by you other physicians may be helpful. Your plastic surgeon... more