Breast Augmentation: Q&A

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My Doctor Didn't Take Photos, So Does the Plastic Surgeon Do This? Will I Even Qualify?

My primary doctor will present my information to my insurance company. I am currently a 40/42 DD, 5'4, and 176 pounds. She didn't take photos and said that they weren't needed. What if not providing this proof to the insurance company doesn't work? It is clearly noticable that my breast are large, so I am guessing that this is why?

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16 Doctor Answers | Asked by Lashay7607

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Breast reduction pre certification request should include photos.

Insurance Coverage for Breast Reduction Article by George J. Beraka, MD Manhattan Plastic Surgeon 80% 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)... more

Insurance coverage of breast reduction surgery

I personally review cases for insurance companies for coverage of breast reduction. The vast majority of them require a photo before they will preauthorize breast reduction surgery. I do not know what sort of insurance you have but I suspect the primary doctor submitted information to get permission for you to see a specialist i.e. a plastic surgeon. The plastic surgeon will then need to see and examine you and then send in a separate preauthorization for your actual surgery. Since the... more

Insurance coverage for breast reduction

Typically, the request for surgical preauthoriation is made by the plastic surgeon and photographs are required. If your primary care physician is requesting an authorization for a consultation, this would not require photographs (some HMOs will not permit consultations without an advance approval) As to coverage for the procedure itself, this would depend on the symptoms, conservative management, your body-mass index and whether you meet the specific insurer's criteria for... more

Preoperative Photos for Breast Reduction

The role of the primary care physician is to make a referral to a plastic surgeon. The plastic surgeon will most likely take photographs. However, not all insurance companies require photographs for pre-authorization. Insurance companies base their decision for authorization on multiple factors, such as: 1.The patient's symptoms 2.What non-operative therapies the patient has tried before (physical therapy, creams for rashes,etc.) 3.The amount of breast tissue that... more

No photos for breast reduction evaluation

Depending on your insurance company, photographs may not be medically necessary for predetermination of breast reduction surgery. The next step is that your primary care doctor should make a referral to a board certified plastic surgeon who can then take measurements and photographs to determine the best method of breast reduction to meet your goals and expectations. I wish you a safe recovery and wonderful result!! Paul S. Gill, M.D. Gill Plastic... more

Photos for breast reduction

Most plastic surgeons take photos of everything and every patient and so it is surprising that yours did not take pre-operative photos. I would ask he/she to do so for documentation purposes even if the insurance company does not require them. I hope that helps!

Breast reduction and photos

I always take my own photos. For approaval of breast reduction through insurance photos are used to evaluate the patient for precertification.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Photos before breast reduction

Many insurance companies do not require photos for the predetermination process for breast reduction, though a few still do. We find it is best to start the predetermination and then send what is asked for to support the request for surgery. The fewer people that have your photos the better. Best of luck, peterejohnsonmd

Photos prior to breast reduction

It is not uncommon to submit a letter and then wait for a request for photos if demanded by the insurance company.

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Predetermination of benefits for breast reduction

Most plastic surgeons will do a predetermination of benefits before a breast reduction, where a letter and preoperative photographs are sent to your insurance company to get preapproval for surgery. Discuss this with your plastic surgeon at your initial consultation.

Photos are not always required for breast reduction insurance authorization

Not all insurance companies require photographs before authorizing breast reduction surgery. However, in my experience it is the plastic surgeon who takes these photos and requests authorization for the operation. The primary care doctor may need to request auth to get you in to see the plastic surgeon, but the surgeon should take it from there.

My Doctor Didn't Take Photos

I would have photos take and find the address your primary mailed the review request to and even the phone #. Than YOU send them and set up a phone contact. YOU need to take control or find a boarded PS to do it for you. From MIAMI Dr. Darryl J. Blinski

Photography and Breast Reduction Insurance Approval

It is not clear from your signature where you live. Your description of the process of Breast Reduction approval by an Insurance company is NOT in keeping with what usually takes place in the US. Depending on your insurance, you may or may not require referral by a PCP / GP to a Plastic surgeon who works with your insurance company ("in network"). During that consultation, IF the surgeon feels that you are a good candidate for the operation, he/she will initiate the approval... more

Surgeon Must Communicate with Ins. Co. for Reduction

It is your plastic surgeon, rather than your family doctor, who would obtain photos and communicate with your insurance carrier to determine if your reduction would be covered. The criteria vary a good deal among companies and different geographical areas. Some insurance policies contain an exclusion for breast reductions without regard to symptoms, etc.

Breast Reduction surgery and photo

If you feel that your large breast (Micronesia) are contributing to your pain and discomfort, you should request a referral from your primary care doctor to see a board certified plastic surgeon. Usually, the primary care doctor will refer you to see a Plastic Surgeon for evaluation. Most primary care doctor do not request the Prue-authorization for breast reduction and have no need to take photos of your breast. During evaluation for breast reduction, the Plastic surgeon should take photos... more

Breast reduction and photos

Every board-certified plastic surgeon takes photos for his or her own analysis and records. A primary care doctor probably does not. Insurance companies and insurance plan within these companies have different criteria for covering breast reduction. If the insurance company requires it, it will probably come for the plastic surgeon. The problem with the process is that an insurance plan may authorize the surgery but not actually pay for it. You are forced to go through surgery without a... more