Insurance Denied Surgery After Breast Reduction Surgery Completed?

Breast Reduction is a complicated procedure that is best done by those with the most training and experience. It is very difficult to determine the resultant cup size and shape based solely on the number of grams that are removed from your breast to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast reduction and lift surgeries, including different approaches, techniques and even fat transfer and implant choices if you are lacking superior breast fullness.This is because several measurements—not to mention breast characteristics such as density—are needed to determine how much and where to remove breast tissue to meet your goals. Without knowing your existing breast shape, dimensions, and the density of your breast tissue, it would be difficult to make this determination. For example, the same volume of breast tissue will weigh different amounts (measured in ounces or grams) in different people depending on its density. The existing base width of your breast and what you will ultimately want to look like will determine, in many cases, the maximal volume and weight that will need to be removed for the best result.Please click on the link below for more information!

I'm sorry to hear about the problem you are experiencing after breast reduction surgery. As you can imagine, online consultants will not be able to help you when it comes to your question about your plastic surgeon's “miscalculation”.

 At this point, I would suggest that you continue to use your plastic surgeon as a resource;  hopefully you both can continue to work with the insurance company to “appeal” coverage for the procedure.

 Otherwise, unfortunately there will be no recourse as to the financial arrangements;  usually the patient is responsible for payment to the “parties” involved.  Hopefully arrangements can be made for “cash discounted” payments.

On the brighter side,  hopefully you will be very pleased with the long-term outcome ( functionally and aesthetically) with the breast reduction procedure performed.

 Best wishes.

Insurance companies have charts to tell them how much tissue should be removed in order for them to cover it as a breast reduction rather than a breast lift with a slight reduction (which they consider cosmetic).  Insurance companies also realize that doctors can only estimate how much tissue they will take out pre-operatively.  Obviously, the only way to truly tell how much tissue will be removed is to weigh it after it is removed.  With that in mind, most insurance companies allow for a little bit of leeway as far as how much tissue they require.  I agree with you that 200 grams is certainly a far cry from 400 grams and I don't know how your doctor was so far off in his estimate.  You would have to ask him that question.  Frankly, I am surprised that they approved an amount of only 360 grams.  Usually they want a lot more than that.  Still, you said that they did NOT deny your claim so it sounds like it all worked out for you in the end.