Insurance Coverage for Reduction / Correction of my Uneven Breasts?

asked 1 year ago by wuzzie12 in saintlouis
Latest answer by Tom J. Pousti, MD
Question viewed 817 times
Tags: 090-109 lbs, 5 ft 0 in to 5 ft 3 in, asymmetry, D cup, DDD cup, insurance

I went to a plastic surgeon, and he said that most insurance companys would cover my surgery because of the fact I'm in really bad back pain and the larger of the two breasts is a 32ddd and weighs about 2 pounds. The smaller is small 32d to large 32c (in 5'3, 108 pounds). I would be getting a reduction on the larger one and that is it. He was pretty confident that I would be covered until I mentioned I had coventry insurance. how can I get them to cover it?

10 answers to Insurance Coverage for Reduction / Correction of my Uneven Breasts?

Breast reduction and insurance companies

Take a look at your insurance policy Explanation of Benefits- if breast reduction surgery is listed as a benefit for YOUR policy, and your a reasonable candidate with good documentation- then there is a good chance insurance will cover the claim. BUT, if your personal policy does not cover breast reduction surgery- there is no way it will be covered. You get what you pay for.

Scott Sattler, MD
Bellevue Plastic Surgeon

Breast Reduction and Insurance Coverage?

Thank you for the question. Based on your description you may be a good candidate for breast reduction surgery. 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 documentation and letter/pictures... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Insurance coverage and breast reductions

Each insurance company has their own criteria for coverage of a breast reduction . The best thing to do is call your company and find out.

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance coverage of breast reduction

Your physician may have had previous more qualified patients who were denied by Coventry and he/she may be speaking from experience. You could ask for a predetermination of benefits letter to ascertain your coverage prior to surgery. This likely would require photographs. Supporting documentation from your other health care providers including chiropractors, physical therapists, and primary care physician could be beneficial to support your case. see video

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Call your insurance company!

Check with your insurance company yourself. See whether or not your policy covers breast reductions. The code to give the insurance company is 19318-50. In Atlanta, Coventry does pay for breast reductions that are medically necessary.

Marisa Lawrence, MD
Atlanta Plastic Surgeon

Breast reduction insurance coverage

Most insurance companies are now using the Schnur scale to determine coverage for a breast reduction. This takes into account height, weight and then amount of breast tissue to be removed. Each insurance company is different. The most important thing is for you to contact your insurance company and ask them for the criteria that are used for coverage of breast reduction. Then take that information to your doctor and that should help get the process going. Hope that helps... more

Josh Korman, MD
Monterey Plastic Surgeon

Insurance Coverage for Reduction / Correction of my Uneven Breasts?

Regarding: "Insurance Coverage for Reduction / Correction of my Uneven Breasts? I went to a plastic surgeon, and he said that most insurance companys would cover my surgery because of the fact I'm in really bad back pain and the larger of the two breasts is a 32ddd and weighs about 2 pounds. The smaller is small 32d to large 32c (in 5'3, 108 pounds). I would be getting a reduction on the larger one and that is it. He was pretty confident that I would be covered until I... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

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... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Insurance Coverage for Reduction / Correction of my Uneven Breasts

My best advise is the see in person the insurance plan's plastic surgeon provider. That doctor will know if you are covered by that insurance plan and will take the necessary steps to obtain a letter of predetermination of benefits for you. You can also call your insurance company to discuss with them the necessary steps to obtain this letter. You need something in writing for your protection. Best of luck. From MIAMI the "real" Dr. Darryl J. Blinski 305 598 0091 more

Darryl J. Blinski, MD
Miami Plastic Surgeon

Insurance Coverage of Breast Reduction

If you are having ongoing back and neck pain that is non responsive to physical therapy, your insurance may cover your breast reduction. This obviously varies from insurance plan to insurance plan. I would closely check on your plan's benefits, and make sure what is required in terms of conservative therapy such as physical therapy, orthopaedic evaluation etc. before your policy would cover your surgery. I would suggest that you call thecustomer representative of your insurance... more