What Documentation Do I Need to Have my Breast Reduction Covered by Insurance?

I have been having back problems since 2006.I started seeing a chiro in 2008, but it got too expensive so I stopped going.Then in 2009 I went to my primary health care provider she also gave me pain pills.I am 5'0 tall and my bra size 38 DDD. So in 2010 I went back to my doctor due to my neck and back hurting so bad i could barely stand.I decided I wanted to lose weight so I went from 203 to 170.Do I need submit all of this to them?I have a rash now is it wise to go to doctor now for documentation?

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6 Doctor Answers | Asked by SD59980 in South Carolina

Doctor Answers (6)
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Breast Reduction and Insurance Coverage?

Thank you for the question. Based on your description you may be a good candidate for breast reduction surgery; for insurance purposes the more documentation of symptoms you have, the better. 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... more

Insurance coverage of Breast reduction

Through the MIB (medical information board), your insurance company should be aware of this. But you should seek a participating physician and have them compose a predetermination of benefits letter to your insurance carrier to discuss you actual level of coverage.

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Breast reduction and insurance

Each insurance company has different criteria for approving breast reduction surgery. It sounds like you are a good candidate and all that doucmentation should come in handy. The bes tthing to do is check with your insurance company.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast Reduction and Insurance Coverage

In summary - 5'0 tall, 170 pounds (BMI of 33.3 qualifying you as Obese) with bra size 38 DDD with neck and back pain and under the breast rash. A private insurance is a contract between you and an insurance company to partially pay (after co-pays and deductibles) for CERTAIN SPECIFIC medical conditions. Large symptomatic breasts may or may not be part of your particular policy, or in their parlance not a covered benefit. If this is the case, it would not make a difference if you... more

Documentation to support insurance coverage for breast reduction

Hi SD59980. Sorry to hear about your troubles. In order to have your insurance company cover breast reduction surgery, you need to build a case and enlist a PS to write a preauthorization letter for you, attaching photos, which will clearly illustrate how you are inconvenienced by the weight and size of your breasts. I would suggest that supportive letters from your Chiropractor, Primary Care Physician, Dermatologist, Orthopedic Surgeon, etc. would be very supportive as... more

Lavinia Chong, MD

22 reviews

Orange County Plastic Surgeon

www.chongmd.com

Criteria for breast reduction

Insurance companies have different requirements for approving coverage of breast reduction. They will need to verify whether the procedure is "medically necessary". Usually this involves documentation of neck and/or back pain, shoulder grooving, and rashes under the breasts in addition to large breast size. You should contact your insurance company directly to obtain their specific requirements. Your plastic surgeon may be of assistance in obtaining pre-authorization for the... more