Breast Reduction: Q&A
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Will Insurance Cover my Breast Reduction Surgery? (photo)
59 inches tall, 102 lbs, extremely slight frame. Bra size is 30E. Neurologist, whom I have visited since 1/2012 because of pain in back, says that breast size is primary etiology of pain and diagnostic tests rule out other causes of functional impairment. Severe restriction of physical activity. Insurer does not have minimum weight to be removed. Plastic surgeon estimates 150 gm per side. Have had two courses of phys ther over 9 months, meds don't alleviate pain, multiple visits to neurologist.
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13 Doctor Answers |
Asked by
SeekingJustice
in Manhattan
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Breast Reduction through Insurance
Thank you for the question and photo.
Although breast reductions are sometimes covered by insurance, I do not think your surgery would be authorized due to the small amount of tissue that needs to be removed. Generally, insurance companies have specific guidelines as to how much tissue needs to be removed (usually more than 150 grams). It won't hurt to submit it for authorization -- best if sent with documentation from other doctors --and see what happens but don't be...
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Breast Reduction Criteria
Breast reductions are covered by insurance companies by meeting 2 criteria. First, you must have symptoms related to the large breasts such as neck, back and shoulder pain or rashes. Second, you must have the amount removed that meets their criteria. I have never known an insurance company to authorize a breast reduction of only 150 grams, despite your small size. I believe you would benefit from a new technique called breast weight transfer. This technique...
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Breast Reduction
Insurance coverage for breas reduction will vary based on the carrier. Although you appear to have a reasonable chance for coverage some carriers require a lot of documentation and physical therapy while others do not. You will need to see a plastic surgeon who has experience dealing with these issues.
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Reduction covered by insurance
It seems based on your comments that you may be a candidate for breast reduction. Whether or not it will be a covered benefit by your insurance policy is difficult to say. I would recommend a consultation with a Board Certified plastic surgeon who can help determine medical necessity of the surgery. A letter will be generated and sent to your insurance company for predetermination. Any additional information you can provide to accompany the plastic surgeon's letter,...
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Breast reduction coverage
Thank you for your question and picture. Based on your description and symptoms, you seem to be a good candidate for breast reduction surgery. You need to have an in person consultation with a board certified plastic surgeon at which point in time your medical necessity will be documented with pictures taken and a letter written through your insurance company. A predetermination for insurance coverage will be made with an estimated amount of tissue to be...
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Will Insurance Cover my Breast Reduction Surgery? (photo)
Only a PREDETERMINATION letter will give you some security as to possible health insurance benefits for your breast reduction. Find a boarded PS to write this letter for you. Best of luck.
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Breast reduction
While your symptoms and body habitus are consistent with the possible need for a breast reduction, I doubt your insurance will cover a 150 gm reduction from each side. Usually they require 350-500 gms/side minimum in mmost cases. Of course, an exam in person is key. Good luck.
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You will probably get insurance coverage for breast reduction.
Hi.
Based on what you say and on your picture, I think you will have insurance coverage. I wrote an article about this topic on my RealSelf profile. You might find it useful.
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Breast Reduction Insurance Coverage
You have done all of the right things to convince your insurance company that the large breasts are giving you significant symptoms. Most breast reductions remove a lot more that 150 grams per breasts so make sure you and your surgeon have come up with the right plan. If you are trying to alleviate symptoms you will probably need to remove more than 150 grams but this weight has not been scientifically established. Make sure you have expressed your desires clearly to your...
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Insurance coverage for breast reduction
Notwithstanding that you do not believe that the insurance company has a minimum gram weight requirement a 150 gram reduction will in all likelihood be dined as cosmetic. 150 grams will not take you from an E cup down to a C and will not alleviate your symptoms. Because you have had conservative medical management, the case should be sent for preauthorization.
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We'll insurance cover my breast reduction.
Thanks for your questions and your photographs.
Unfortunately, it has become ever increasingly difficult for patients to get breast reduction covered by insurance. In recent years insurance companies have increased the number of grams that need to be removed in order to be covered. Setting up a well documented history of your discomfort and the need for breast reduction helps, but still may not satisfy your insurance carrier.
I practice in the state of Maryland where it...
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Doubtful with that small reduction
You need to speak to the insurance company, most require over 450 + grams/side to be reduced in order to pay for it. The plastic surgeon you go to should explain all that to you and help you with insurance reimbursement.
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Weight Of Tissue In Breast Reduction
It certainly sounds as if your breast reduction should be a covered benefit. Have your plastic surgeon communicate with your carrier. Even though your insurance company does not5 specify a weight to be removed, I would suggest removing more than 150m grams in order to improve your symptoms.
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