Am I a Candidate for Having Insurance Cover my Breast Reduction?

asked 8 months ago by CSMKVRET in Buffalo, NY
Latest answer by David Bray, Jr, MD
Question viewed 195 times
Tags: age 45-54, female, back pain, candidate, neck pain, shoulder pain

50 years old, 5'8" and 210lbs. Currently I am a 42DD. Last year I weighed 240, even with wight loss breast size has not decreased. I've also been diagnosed with hypothyroidism - hence losing additional weight has been challenging and I seem stuck. Insurance denied request of 500 gram reduction stating the Schnur Scale states 750 would need to be removed. I have deep groves in my shoulders, pain, cardio is challenging etc. My pant size is a 14, my top size is an 18. Do I have any recourse?

5 answers to Am I a Candidate for Having Insurance Cover my Breast Reduction?

Insurance coverage

The more documentation that you can provide to demonstarte medical necessity the better. Many patients will have neck and back pain related to large breasts. If you have seen other physicians or health care providers for these symptoms providing this information may improve your chances with an appeal. Chronic rashes underneath the breasts may also occur. Photodocumentation of this problem as well as documentation of treatment of this problem may... more

David Bray, Jr, MD
Los Angeles Plastic Surgeon

Problems obtaining insurance authorization for breast reduction

Did a plastic surgeon assess you and estimate that 500 grams would be removed per side? If he/she did and submitted this information to the insurance company only to be denied coverage for a breast reduction, you do have an option to have this appealed to someone higher up in the company. If you have clear cut evidence and documentation of physical issues and problems related to your large breast size, you may be able to have the initial rejection reversed. I have had success with many of my... more

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon

www.turkeltaub.com

Insurance coverage for breast reduction.

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... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Getting Insurance to Cover Breast Reduction

Each insurance company has it own guidelines. Most require 500 grams of tissue to be removed from each breast. Since you have been denied coverage, there is one more thing you can try. Most insurance companies allow you to appeal their decision, in which case a doctor would contact your surgeon to discuss your case. I have had more than one reversal in this situation, so it is definitely worth a try! Good luck. see video

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon

www.dr-delgado.com

Breast reduction insurance coverage?

Based on your description you may be a good candidate for breast reduction surgery; as you know it may be in your best interest to drop weight first. 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... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

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