I have cigna healthcare in georgia I wanted to know will they deny me for not having documents of therapy? I lost 52 pounds now at 139 pounds. I have indentations on my shoulders,headaches daily, tention in my neck,pain when i raise my arms up,and numbness in my hands sometimes. my bra size ia a 36DDD,they did not go down at all after the weightloss:( I did see a ps and he said i was a candidate for the surgery, so i am waiting for the insurance company.Do you think i will get approved?
Does All Insurance Co Like Cigna Make You Do a 3 Month Trial of Therapy for a Breast Reduc
Doctor Answers (6)
Breast reduction approval
Hard to say whether or not your insurance company will approve your breast reduction. Each company is different and require different things to get approval. I have been in practice for about 15 years and I still can't figure them out.
Therapy before breast reduction
Each insurance company and plan will have unique criteria for breast reduction. Several do require a trial of physical therapy of three months, and some even a year before reduction can be considered. From an insurance standpoint they are looking for the least cost alternative in the management of back pain and cervical strain. Your benefits administrator is a good source to sort out what your plan will require.
Best of luck,
Web reference: http://www.peterejohnsonmd.com/breast-reduction
Insurance and breast reduction
Our office specializes in "Scarless" breast reducion, which uses liposuction only. As we are removing only the fat from the breast and not doing a lift operation we consider this to be purely functional and it makes sense that the insurance companies would be happy to cooperate but once they hear the word liposuction they've found a way out of their obligation. Sorry I can't be of any further help but we do not accept any form of insurance for this operation.
Sherwood Baxt, MD
Board Certified Plastic Surgeon
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Qualifying for breast reduction
It seems to be the norm, at this point, for insurance companies to require a trial of conservative therapy from 3 to six months. They require documentation of back symptoms for 6 months and some type of physical therapy etc. for 3 months.
Breast reduction and insurance companies
You appear to have a compelling case for breast reduction funding through your insurance company. The problem is getting your insurance company interested in paying for the operation that will undoubtedly improve your overall quality of life and likely improve your neck/back/shoulder pain. Insurance companies are incredibly restrictive when paying for this operation. Make sure you have at least 3 months of documented medical care for 'conservative treatment', document your use of pain medication (keep a dated log), good photographs and a letter from your primary care and plastic surgeon. With these documents in hand, its likely your procedure will be approved. If breast reduction is specifically excluded as a 'benefit' from your insurance policy, then you are out of luck, so check on this (read your policy).
Insurance Companies and Breast Reduction Surgery
Each insurance company is different. Sometimes, breast reduction surgery can be covered by medical insurance. Each insurance company has it's own criteria as to when they will "approve" the procedure. You may need to call your insurance company to see what their exact criteria are. I see patients and take photos and submit those photos along with any other documentation that a patient may have from Chiropractors, primary care doctors, etc.(. that state that she is having pain, discomfort, etc. due to the large breasts) to the insurance company for approval.
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