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Is There a Chance my I.C Won't Cover a Reduction? I'm 5"7, 38 DDD with Rashes and Pain.

asked 11 months ago by Daenyris in Temple Hills, MD
Latest answer by Tom J. Pousti, MD
Question viewed 199 times
Tags: back pain, candidate, insurance, rash

I dont have really severe grooves in my shoulder because I use shea butter and I wrap my straps up. However, I do have the back pain, rashes and grooves under my breasts, and I recently had fluid build up in my shoulder which led to severe pain in my arm. I know I fit the requirements but you never know with insurance companies.

8 answers to Is There a Chance my I.C Won't Cover a Reduction? I'm 5"7, 38 DDD with Rashes and Pain.

+1

Breast Reduction Candidate?

Thank you for the question. There is no doubt that your very large breasts may at least be contributing symptoms you are suffering from. Breast reduction surgery is one of the most patient pleasing operations we perform. 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... more
Tom J. Pousti, MD

San Diego Plastic Surgeon
+1

Will insurance cover my Breast Reduction

You hit the nail on the head...you never know with insurance companies. Some plans exclude breast reduction no matter what the patients' symptoms are. While it sounds like you have many of the symptoms that should qualify you for insurance approval, you just never know. I have been in practice for 12 years and still can not make heads or tails of why they approve some patients with minimal symptoms and deny others with gigantic breasts and deep shoulder strap grooves... more
Laurence Weider, MD

Dallas Plastic Surgeon
+1

Breast reduction coverage

Each insurance company has different criteria to approve breast reductions. You have to check with yours and go from there.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Insurance coverage for breast reduction

Not only are there differences between insurance companies as to what they will cover, but a single insurance company may offer different policies. So it will depend not only on your insurance company but your individual policy. Your board certified plastic surgeon should be able to get a prior authorization from your company as to whether your policy covers the procedure and if there are any criteria (for example how much tissue must be removed) for coverage. If they won't cover it, you... more
Margaret Skiles, MD

Sacramento Plastic Surgeon
+1

Insurance Coverage of Breast Reduction

It sounds as if your breast reduction would be covered considering the information that you provided. Most women with symptoms and 38DDD breasts would be covered. There is a good bit of variation, however, and some policies contain an outright exclusion of coverage of this procedure. Your best bet is to obtain a consultation with a BC plastic surgeon who can then communicate with your insurance carrier.
John Whitt, MD

Louisville Plastic Surgeon
+1

Is There a Chance my I.C Won't Cover a Reduction? I'm 5"7, 38 DDD with Rashes and Pain.

With a well written letter of predetermination you should be able to achieve a covered approval. This is based upon your history, physical findings, photos, tests.
Darryl J. Blinski, MD

Miami Plastic Surgeon
+1

Your surgeon should write a letter to ask them.

There really is no way to know if your insurance will cover the procedure. Your surgeon will make an estimate on how much tissue needs to be removed (in grams) and the insurance company has a criteria for weight and height to how much needs to be taken off. If these numbers match, and you have some of the symptoms, you will get approved. Good luck!
Bivik Rajnikant Shah, MD

Columbus Plastic Surgeon
+1

Breast Reduction - Is There a Chance my I.C Won't Cover a Reduction? I'm 5"7, 38 DDD with Rashes and Pain.

Hi Daenyris, Exactly right, you never know - so you have to find out. Each insurance company is different and has its own requirements as to what will be a "covered" procedure (in quotes because the next issue is finding a surgeon you like who will accept what the insurance company says is adequate compensation as payment for the surgery). There is typically a minimum reduction of about 500 grams (a little over a pound) from each side, but those standards should not... more
Alan Engler, MD

New York Plastic Surgeon

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