Insurance Denied Coverage of Breast Reduction - How Can I Appeal?

My insurance has denied authorization for breast reduction surgery. What would be the best info to appeal their decision? I have a worn T5 in my curved spine and suffer from low back referred pain as well. I am very tired of living with these conditions. I also have fibromyalgia that my insurance reviewers considered to be the primary cause of my pain. I need some relief!

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6 Doctor Answers | Asked by Sad Sandy in NE South Carolina

Doctor Answers (6)
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Breast Reduction and Insurance Company Appeal?

Thank you for the question. As you have found, it can be very frustrating dealing with insurance companies. I would suggest you write an appeal letter and have your physicians do the same. Be persistent. Best wishes.

Breast reduction and insurance

Every insurance company is a bit different with regards to coverage for a breast reduction. You should contact your insurance company to find out their criteria. You would have to appeal the denial as well.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast reduction and insurance denial: send a 10 pound bra to Insurance CEO

There are no secret weapons but persistence is a virtue when it comes to insurance companies. Consider taking a 10 pound weighted bra into the CEO of the insurance company and asking him/her to wear it 24x7 for just one week.

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Breast reduction and insurance and costs

Yes, I would suggest you appeal. We are able to pre-authorize our patients based on the amount that I plan on removing as well as dermatologic problems under the breasts.

Breast reduction insurance coverage

Answer 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 C cup) will usually be covered. 3)... more

Insurance Breast Reduction Coverage

What you need to do is talk to your insurance company and see what it takes to get authorized from their perspective. With that infomation, you can then talk with your surgeon and see what may need to be done. Some want you to go to physical therapy first, while others want notes from an orthopaedic surgeon, etc. It can be a struggle, but just keep fighting with them and see what it is going to take.