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How to Succsesfuly Get Insurence to Cover Breast Reduction?

asked 6 months ago by breast.idea.ever
Latest answer by Kelly Gallego, MD
Question viewed 165 times
Tags: coverage, insurance, pain

putting in an insurence claim for breast reduction, I am 5'3, 130lbs and a 32DD. What are my chances of success? My doctor agreed right away and started the claim, I have done 3 years of physical therapy with no such luck of back strengtheng etc.. My usual weight is 117-120, but with so much pain exercising is not the easiest. Is there anyway I can succsessfuly be granted this procedure?

11 answers to How to Succsesfuly Get Insurence to Cover Breast Reduction?

Insurance coverage for breast reduction

Insurance companies want to see proof of conservative management, such as physical therapy, but also have standards for the amount of breast tissue that must be removed. In NY, that amount is typically 500 grams of tissue per breast. You would need to see a board certified plastic surgeon in consultation, bring your treatment records, have him apply for preauthorization and then see what the insurer says. They are usually more cooperative with in network physicians as there is a... more

Robert L. Kraft, MD
New York Plastic Surgeon

www.foresthillsplasticsurgery.com

Breast Reduction and Insurance coverage.

Thank you for the question. It sounds like you are dealing with breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for the frame causing both physical and psychological distress. Based on your physical description you may be an excellent candidate for breast reduction surgery that will hopefully be covered through your insurance plan. Unfortunately, there is no way of knowing whether a... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Breast reduction and medical insurance

Breast reduction continues to be an extremely common procedure in the United States. In my practice, the majority of breast reductions are paid for by insurance companies. Each insurance company is different in regards to what they deem medically necessary. Typically it has to be proven that severe symptoms exist such as neck, shoulder and back pain, rashes under the breasts, shoulder grooves, and even arm numbness. In addition, it must also be shown... more

Kelly Gallego, MD
Sioux City Plastic Surgeon

Insurance coverage for breast reduction

Insurance coverage is a contract and each contract varies--even from the same insurance company. And there is a lot of fine print in most health insurance contracts. In general, however, for insurance to cover any surgery, it must be medically necessary and for breast reduction, many companies also have a minimum amount of tissue that must be removed. Your board certified plastic surgeon is in the best position to help determine whether you meet your insurance companies criteria by getting a... more

Margaret Skiles, MD
Sacramento Plastic Surgeon

Insurance coverage for breast reduction

Thanks for your question as this is a commonly asked question. The inusrance company will cover breast reduction if; You have had physical symptoms related to heaviness of the breast tissues. Conservative and medical treatment has not been successful. History of back pain, shoulder pain, or skin rash. Discuss this in person with a Board certified plastic surgeon as they would be able to help you with gathering the necessary documentaion in conjuction... more

Ali Sajjadian, MD
Orange County Plastic Surgeon

www.DrSajjadian.com

Insurance company approval for breast reduction

Insurance companies have different criteria of eligibility for coverage for a breast reduction. Furthermore, some insurance plans from these same companies exclude coverage for this surgery - so you will need to find this out. It appears that your breasts are significantly enlarged and in the range where approval may be a possibility. Most insurance companies require a minimum gram weight of breast tissue to be removed and this amount is often based on your height and weight.... more

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon

www.turkeltaub.com

You can probably get insurance coverage for breast reduction.

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points. 1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches. 2) Very big reductions (like from an F cup to a C cup) will usually be covered. 3) Many policies will pay for breast reduction if 500 grams (a... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast Reduction, Insurance coverage

Each insurance carrier is different in what they require to cover breast reduction. And groups of policies inside the same insurance company may differ as well. Let your surgeon's office handle this for you, they are used to it. In the meantime the person in the doctor's office that does the insurance work shoulod be able to gibve you at least some idea of the likelihood of your company covering your surgery. Good luck, it sounds like you would definitely benefit from the procedure. more

Ronald V. DeMars, MD
Portland Plastic Surgeon

Gettin Insurance Coverage for Breast Reduction

Each insurance company has their own criteria for qualifying for coverage. Most require the needed amount of breast tissue to be removed is 500 grams per breast and that is usually a DD cup. They also want documentation of physical therapy, medications tried, good support bras, anything you have done that did not help. It sounds like you would be a good candidate, as long as your insurance does not have an exclusion for breast reduction, you should get approval. If for some reason you are... more

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon

www.dr-delgado.com

Insurance Coverage for Breast Reduction

Here is the advice I share with my patients: 1. Gather documentation. Letters from your primary care physician, OB-GYN, orthopedic surgeons, or chiropractors are helpful, as is documentation of failure of physical therapy. 2. Take pictures. If you have ever had a rash below your breasts, get a photo. A letter from a dermatologist can also help. 3. Check with your insurance company. It used to be standard that 500 grams of tissue had... more

Danielle DeLuca-Pytell, MD
New York Plastic Surgeon

Breast reduction authorization depends on your insurance policy

I am always amazed at the labyrinth of coverage from insurance policies and how easy it is to get pre-authroization on some patients and how dificult it is on others...from the same insurance company! I have several patients who worked for the big insurance companies in my state and their answer is that there are vastly different coverages in policies. It is in the fine print that no one ever reads. In general the less expensive the policy the more likley it is that it only... more