Am I Canidate for a Reduction Through Humana?

I have been reading and researching breast reduction that I do think I need, but I have noticed that insurance companies set guidlines and if you are a valid case for the reduction. I am 30 yo, done having kids, 5'10", 200 lbs and wear a size 38DD. I have suffered from migraines for about 8 yrs now. My nero dr and I decided it was muscle tension in my neck and shoulders. I also get back pain and spasms. Do you think my insurance (humana) will see me as a canidate? I'm worried I won't be.

Doctor Answers (2)

Humana Breast Reduction Coverage

+1

Based on your description, it sounds like you are a candidate for insuance coverage of the procedure. Consult with 2 - 3 board certified plastic surgeons who participate with humana for the best possible chance of reimbursement. They will be most familiar with the documentation requirements which generally include independent physician verification of medical necessity (i.e. imary care doctor,  neurologist, physical therapist, chiropractor etc) and documentation including letter/pictures from your plastic surgeon.  Persistance will be the key in working with insurance companies.  Generally, if you choose your surgeon well the results will make the aggravation worthwhile.


West Palm Beach Plastic Surgeon
4.5 out of 5 stars 14 reviews

Breast Reduction and Insurance Coverage?

+1

Based on your description you may be a good candidate for breast reduction surgery; it will be in your best interests to achieve a long term stable weight prior to undergoing surgery.  

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,  neurologist, 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 board-certified plastic surgeon.  

Prepare to be persistent with the insurance  company.  Keep in mind, that breast reduction surgery is one of the most patient pleasing operations we perform.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 679 reviews

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.