How can I get info from insurance?

I am 34 and 34ddd/G I recently visited my ps and he said I was a good candidate for BR. I asked him if I should get additional info from my pcp for insurance he said not to worry they will approve me, but 4 weeks later BCBS of SC denied my surgery. And they refuse to tell me their criteria to get approve because it is covered in my policy and I had two friends with the same policy that was approve with no problem. What should I do next?

Doctor Answers (3)

When Insurance Denies Breast Reduction Surgery

+2
It is unusual for your insurance company not to give reasons for denial, ask your surgeon to appeal your case, I have gotten many patients approved this way. Good Luck!


San Francisco Plastic Surgeon
4.5 out of 5 stars 29 reviews

How can I get info from insurance?

+2
In my experience, either you and/or your plastic surgeon should be able to request a copy of the “criteria” used to approve or deny coverage for breast reduction surgery. You should also be able to read  the  reasons why your breast reduction procedure was denied.
Based on your description, you seem like you may be an excellent candidate for breast reduction surgeon. Continue to be persistent with your insurance company and have your plastic surgeon help you with a letter of appeal.  Hopefully, your efforts will be rewarded; this operation tends to be 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 710 reviews

Letter

+1
Insurance companies usually send you and your surgeon a letter that explains why you were denied.  You cannot compare your case to your friends since it depends on your specific policy and your specific history, measurements, exam, etc.  It may be an exclusion on your policy.  Have you checked into that possibility?

Emily J. Kirby, MD
Fort Worth Plastic Surgeon
5.0 out of 5 stars 4 reviews

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