My Insurance Denied a Breast Reduction. How Can I Get my Insurance To Cover a Breast Reduction for Me?

I'm 17, only 4"11 feet tall weighing 138lbs. With 40DDD BOOBS!!!!! My back, shoulders and neck hurt so bad all the time. I'm always in pain and nothing helped. So I tried to get a reduction and was denied... I dont know what to do please someone help. !!!!!

Doctor Answers (4)

My Insurance Denied a #BreastReduction.

+1

Each insurance company has its own policies for this and other issues.  It sounds like you should be a candidate for this surgery, assuming your symptoms have not been relieved by conservative methods (which is often used as criteria).  However, you'll have to find out from your insurance company exactly what is required.  You will probably need help from your plastic surgeon to write to your company, include photos and documentation of failed conservative treatment(s).  I would hope that this is enough to get approval.

I hope that this helps and good luck,

Dr. E


New York Plastic Surgeon
5.0 out of 5 stars 150 reviews

Getting Insurance to Cover Breast Reduction Surgery

+1

Different insurance companies have different guidelines for approving surgery. Some require that you be 18 years of age. Since you are experiencing pain, I would ask your surgeon to appeal your case, they will have a medical doctor call your surgeon to discuss your case, many times the decision can be reversed in this way. Good luck!

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 30 reviews

Insurance coverage for breast reduction in Los Angeles

+1

Insurance coverage varies greatly.  I would discuss your insurance plans decision with the reviewing clinician by calling them and reviewing their decision. I perform many of these procedures and have found the insurance companies to be fair in their approach. Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 47 reviews

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Take the bull by the horns and be proactive

+1

Insurance company decisions do not have any consistency.  There is a rising number of payors that exclude reduction surgery regardless of circumstances.  However if that is not the case, I would write an appeal letter.  In that letter:  1.) make it clear that you are seriously pursuing this, 2.) Include letters from chiropractors, family physician, physical therapist and anyone else that has no financial interest in you having surgery. 3.) include info about what you have done to improve the situation  yourself (ie. Wt. loss, etc) 4.  Copy of letter to your state insurance commish  5.) Discuss with a lawyer.Or....you can work out a deal with your doctor and just pay for it yourself

K. Dwayne Fulks, MD
Chattanooga Plastic Surgeon

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.