I would like to get an evaluation for a breast reduction? How do I start the process? Do I start with my general physician for a referral?
Where Do I Start For Breast Reduction?
Doctor Answers (6)
It is best to start with your primary care provider
I think it is typically best to start with your primary care provider. You should have a frank discussion about all of your symptoms such as pain, rashes, shoulder grooves, headaches, etc. They should clearly document your complaints. They should also administer the appropriate conservative therapies. In addition, they should be able to facilitate a referral to a respected board certified plastic surgeon in your area if the conservative therapies prove ineffective, as they generally do.
To get things moving quickly you should probably see a plastic surgeon first if you think you are a candidate for a breast reduction. Different insurance companies will request different things, so you will have to find out what they require.
Breast Reduction; Where do I Start?
Thank you for the question.
If you are dealing with an HMO insurance plan, you will likely need to meet with your primary care physician for a referral to a plastic surgeon in the plan. If you are covered by a PPO insurance plan, then this referral will not be necessary. The same will hold true if you are paying for the breast reduction procedure out of pocket.
Ultimately, it will be up to you to do your due diligence in the process of plastic surgeon selection. I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.
Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.
If you are having the procedure covered by an insurance company, there will likely be 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 insurance “authorization” for the procedure. This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.
I hope this helps.
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Investigating breast reduction surgery
There are basically two pathways to consider, one with insurance coverage, the other as a cosmetic (self-pay) procedure. For insurance coverage you need to follow the rules of your insurance company: some require referral from your primary care doctor, some don't; some require failure of conservative therapy first; some have requirements as to how much tissue must be removed, etc. Your doctor (primary care and/or plastic surgeon) should be able to help you with your insurance companies requirements and authorization procedure. If you opt to pay for it yourself, you can see a plastic surgeon in your area. In any case, your surgeon should be board certified by the American Board of Plastic Surgery and you should feel comfortable with him or her. Good luck to you.
The question starts whether this is a procedure that you would want to pay via your insurance plan. If yes, then you should know the qualification criteria for your plan. Second, the insurance company will pay more if the surgeon selected is in their network. Review the list of surgeons that participate in the network. Thirdly, choose 3 for consultion. The one that best meets your needs through his/her expertise, experience, and understanding of your needs would be the one that you should opt for.
If you do not have insurance or do not qualify under the criteria of your plan, then skip to step 3 and consult with 3 surgeons in your area who have the experience and expertise to perform the surgery.
Breast reduction questions
If you are considering using your health insurance to see if they will cover a breast reduction, you should start by seeing your primary care provider to see if there is a plastic surgeon in your network. The plastic surgeon would then need to see you to determine if they believe the insurance will cover. They would then have to submit paperwork, probably with photos to be reviewed. I hope this helps.
Web reference: http://www.medwardsmd.com/plasticsurgery_questions1.html
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.
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