Can You Clarify "3 Months Conservative Treatment" for Breast Reduction Insurance Coverage?

asked 1 year ago by Mindwhirl
Latest answer by Tom J. Pousti, MD
Question viewed 157 times
Tags: conservative, insurance, treatment

To qualify does the treatment have to be 3 months of ongoing PT or chiropractic care, etc? Or can it be 3 months of a combination, such as seeing a chiropractor for 20 sessions (the limit of my insurance), then taking an NSAID and using a heating pad for a couple months?

Does a self claim of use of OTC naproxen and/or ibuprofen count towards the treatment, or does a doctor have to be seen and recommend the meds?

7 answers to Can You Clarify "3 Months Conservative Treatment" for Breast Reduction Insurance Coverage?

Breast Reduction and Insurance Coverage?

Thank you for the question. "Conservative therapy” may be defined differently by the various insurance companies. In my opinion, this is a simple stalling technique, since these measures do not significantly improve patients symptoms associated with breast hypertrophy. Unfortunately, in order to have the breast reduction covered by the health insurance company it is necessary to jump through their hoops; it will be in your best interest to determine what... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Conservative Therapy Has Different Meanings for Different Insurance Cos.

Conservative therapy has different meanings to different insurance cos., but is essentially always a ruse to delay or avoid coverage. PT, chiropractic care, and NSAIDS are among the treatments they refer to, but none of these nor any other "conservative therapy" will correct pain due to breast hypertrophy.

John Whitt, MD
Louisville Plastic Surgeon

Breast Reduction - Coverage, What Constitutes "Conservative Therapy"?

Hi Mindwhirl in Northern IN Each insurance company is different and has different requirements before coverage would be considered for a surgical procedure. The best thing for you to do is to work WITH a plastic surgeon you like. You'll need that surgeon to submit a letter of proposed treatment, and you can ask him or her to help you find the answers to these questions. Or you can find out yourself. Contact your insurance company and find out EXACTLY... more

Alan Engler, MD
New York Plastic Surgeon

3 months "conservative" treatment

As you can see from all the notes Plastic Surgeons do not necessarily agree with this insurance "requirement". According to the insurance(s) I tried to clarify this with, they want to see a non-operative effort of three months to treat your complains of back-, neck-, shoulder pain. A physician (it can be a primary care Doctor, Chiropractor, Orthopedic Surgeon ) who prescribes you a "conservative" treatment such as Physical therapy (we... more

Guido P. Gutter MD
Evansville Plastic Surgeon

Breast reduction an insurance

Welcome to the world of insurance coverage for breast reductions! Many insurance companies in the NorthEast want documentation of neck and back pain brastrap grooving or intertrigo( rashes) fro 3-6 months. This has to be documented by the treating physicians for the given problem. Yes, I know what your are thinking. They want to make the process laborious and difficult so that fewer people can be approved.

Steven Wallach, MD
Manhattan Plastic Surgeon

Breast reduction insurance coverage.

Insurance Coverage for Breast Reduction Article by George J. Beraka, MD Manhattan 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... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast reduction insurance coverage

Your insurance provider can detail exactly what they mean by "conservative treatment", but generally all of the examples you gave fit into that category. Usually they do not specify that you should have a single specific therapy, but a combination of therapies. As far as medications, they certainly consider prescription strength medications more seriously than OTC. Also keep in mind that if you have problems with skin irritation and infection underneath your breast (a condition called... more

Derek Lou, MD
Houston Plastic Surgeon

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