I am heavy )5'5", 240 lbs. Could that be the reasoning behind the doubled request?
My Dr. Ordered 800 CC/breast. My Insurance Said It Needs to Be 1800. Is That Risky?
Doctor Answers (12)
Promoted Local Answer Promoted local answers are based on Featured Doctor activity within your current location.
800 or 800 CC breast?
Hello, and thank you for your question. I'm not sure that I understand your question. I give it a try.
It sounds as though you're considering a breast reduction. If I'm mistaken you can pretty much ignore the rest of this answer.
If a breast reduction is to be covered under insurance which is becoming increasingly more difficult we generally submit photographs of the patient, the indications for the surgery, and an estimate of how much tissue will be removed to the insurance carrier. With this information the insurance carrier may approve or disapprove under the your policy coverage for breast reduction surgery.
It sounds and your question is though your doctor Estimated about 800 g per breast, but your insurance carrier may not be willing to cover your surgery unless he takes off 1800 g? 1800 g is a huge amount of breast tissue so again I apologize if I'm not understanding the question. For example Blue Cross generally requires about 600 g per side.
You may want to post this one again with a little bit more detail.
1800 sounds incorrect
As the other surgeons have mentioned, in order for a breast reduction to be "medically necessary," it must meet certain criteria. For the amount that is required by your height and weight, you are looking at somewhere between 900-950 gms per breast in order to meet at the 22nd percentile, which is what most insurance companies require. 1800gms might be your individualy carrier's criteria. This is could also be both breasts, which is fairly close. I would contact your insurance carrier's representative to discuss what your plan requires.
In addition most insurance companies will require more documentation and reasoning as to why it is medically necessary to reduce the size of your breasts than just a size issue. You should discuss this further with a board certified plastic surgeon to understand what your insurance company requires.
Without an exam, I could not assess an approximate weight that might be removed during a breast reduction.
You might also like...
Sounds like you are talking about breast reduction surgery, if so the amount to be removed is measured in grams not CCs. Each insurance company has its own criteria for height and weight and it looks like the 1800 grams are what they expect removed from both breasts in total and not from each breast. Hope that helps.
Insurance Reduction Requirements Do Relate To Weight
Almost all insurance companies do relate the amount of breast tissue removed to the patient's BSA (which tends to penalize women who are taller). 1800 grams of tissue does seem excessive if it is expected from one breast. If this represents the total weight from both breasts, it probably is accurate.
You can calculate your requirements for breast reduction if you have internet access.
Most insurance companies abide by the Schnur Scale. Use an online calculator to determine your body surface area in meters squared and then go to the following web reference to determine the amount of breast tissue removal that is required for you. Then, call your insurance company to see if they use the Schnur Scale as well. I hope this helps.
1800 grams per breast is a very large reduction. If the insurance company is calculating the minimum that it will allow for your height and weight, that is possible, although I have never seen an insurer express it in those terms. They either approve or deny the reduction. Plastic surgeons do not "order" a set number of grams per breast. They estimate how much they intend to remove during the procedure and the insurer responds. I agree with other posters that there is some miscommunication going on and that you need to speak to your doctor to clarify what is going on prior to proceeding with surgery.
If you are talking about breast reduction and grams (not ccs) to be removed, here are my thoughts.You need to get better communication with your surgeon. I bet he preauthorized 800gm per side and the insurance company wants 1800gm total. If so, you're close to covered. But few of us will remove breast tissue until we meet the insurance company's "requirements" because to do so may create a very deformed breast. So better get this cleared up.
1800 cc breast implants
You miss-understood. There are no 1800 cc breast implants made in the USA. Larger sizes are made in Europe. Risk is not more if done by an expert in stages. You can't go from zero to 1800 cc in one step. It takes expanders first and a remove & replace later. You should be the one to decide the size you want to be, not the doctor. We help our patients make that decision with several different methods. Dr Foster
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.