Breast Reduction: Q&A
Ask a Question
Insurance Denied my Breast Reduction Surgery, How Do I Make a Case for an Appeal?
25yrs old, 5'3" and 165lbs and my cup size is 34G, denied coverage for breast reduction based on the Schnur scale. Surgeon wants to remove 250g from left breast and 300g from right but scale says to make a symptomatic difference I'd need twice that removed! The ins. company also deemed it cosmetic due to ptosis (sagging breasts) and the fact that a lift would be included in the procedure. Doubled sports bras cause discomfort and trouble breathing so I can't exercise and lose weight due to pain.
Tags:
6 Doctor Answers |
Asked by
usmcwife08
+2
Breast reduction insurance denial
I tell my patients that the insurance companies are businesses. They are not going to cover a surgery that seems at all to be simply a cosmetic procedure. I also tell my patients to be honest with themselves. They should not expect the insurance company to cover a procedure that is not medically necessary. If the breast reduction surgery for you is needed to relieve back and neck pain or reduce skin rashes along the IMF, you should not have trouble documenting this being a problem for you....
more
+1
Breast reduction denial.
Thank you for your question,
As you've already seen is very difficult in this day and age to get breast reduction covered through Medical Insurance. If you're going to appeal your best bet would be to gather supporting information from Physicians in charge of your care who document that breast reduction will indeed be in your medical best interest.
Even in this situation some insurance companies simply do not cover breast reduction as part of their plan. This is...
more
+1
Breast reduction denial
If you are truly a G cup, then a reduction of 250/300 g would be minimal and would not be within insurance guidelines. A lift is, per se, part of the reduction operation and this is not the reason your procedure was denied. It was denied because the amount of gram weight is below all reasonable standards, making the operation appear to be cosmetically motivated and, in essence, a lift. Typically, the denial is a form letter and, thus, refers ot the Schnur scale. You can read the...
more
You might also like...
Real Stories
Removal 500 Grams 5'1" 150 Lbs - Dallas, TX
I was approved for a breast reduction but I am concerned on how much the insurance says...
+1
Insurance and Breast Reduction
It is difficult to get insurance coverage for breast reduction unless you have plenty of documentation. You may need an orthopedic consult to prove the breast are causing injury to your neck and back. Did your surgeon send photos to the insurance company? Has your primary care physician or GYN ever suggested you see someone about a breast reduction? Is so, get them to write a supporting letter for your plastic surgery to attach to the appeal. Some of the bra...
more
+1
Denial from Insurance for Breast Reduction Surgery
Thank you for your question.
I am sorry that your insurance company denied authorization. Each insurance company is different with what they want for approval and their criteria for authorization.
You can try to have your surgeon send an appeal but also include documentation from other doctors you have seen for issues related to the large breasts (ie) chiropractors for back/ shoulder pain, primary care doctor if you have rashes, etc..
Those supporting letters may help...
more
+1
Insurance and breast reduction
Breast reductions are not all covered by health insurance. They have made it harder and harder to get covered. Sounds like you will have to pay out of pocket to get it done. Good luck.
Comments (4)