Will insurance cover my breast reduction if I get clogged pores, skin tags, and back pain; and what are the requirements?

From research I see it might be possible. I do get a lot of clogged pores under my breasts, have had many skin tags and deal with back pain (though I have never consulted with my doc about the pain) what are the typical requirements for insurance to approve?

Doctor Answers (3)

INsurance Covering Breast Reductions

+1
Thank you for your question. Unfortunately my experience has been the same as Dr. Kraft, who has written below. The insurance companies in California ask for a photograph and an estimate from the surgeon as to how much breast tissue will be removed. Another company tactic is to deny coverage based on the patient's weight in comparison to their height. If the patient is "overweight" they will deny coverage until the patient is able to loose weight.

The companies make a distinction between "large breasts" and "abnormally large breasts" - even if a woman with only "large" breasts has significant back, neck, and shoulder pain. Sadly our health insurance industry is profit, not patient driven. The companies profit by denying care to the patients. 


San Francisco Plastic Surgeon
5.0 out of 5 stars 5 reviews

Will insurance cover my breast reduction?

+1

 Thank you for the question.
Based on your description, you may be an excellent candidate for breast reduction surgery. This operation tends to be one of the most patient pleasing operations we perform. 
You will need to check with your insurance company directly to see whether your policy covers this operation. They will also be able to tell you whether you will have any direct responsibility/expenses if you choose to undergo this procedure.
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 from your plastic surgeon will help you obtain authorization.
 I hope this, and the attached link, helps. 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 681 reviews

Breast reduction preauthorization

+1
The requirements keep getting harder.  Some insurers will require 6 months of documented chiropractic or physical therapy; back x-rays; orthopedic consultation, etc.
They have gotten so strict that they won't accept a letter from the physical therapist; we have to hand in all the chart notes, too.  Clearly, the insurance companies are looking for every excuse to deny surgery.  Skin tags, clogged pores, etc. would not be considerations leading to approval.  

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

You might also like...

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.