What's the Chance of BCBS of MI Approving Me POST-OP? (photo)

I am 5'4 about 207lbs w/ 36H and was referred by my OBGYN in Jul to my PS for a BR. At my consultation last Friday, the PS said w/ a small frame and with the some of the symptoms I have had (neck/back pain, deep indents frm bra straps, bad posture) def. thinks I would benefit from a BR. Also said they are very heavy and made it hard for him to measure even.He's thinking he will remove 800-900grms to get me to C/D. BCBS said they don't do PAs for BRs. What are my chances of being aprvd post-op?

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H cup 5 ft 4 in to 5 ft 7 in 190-209 lbs Blue Cross/Blue Shield

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4 Doctor Answers | Asked by ImMizzAO

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Predetermination is best before breast reduction

We are not in Michigan, though nearby in Illinois we always complete a predetermination with Blue Cross to find out if breast reduction is a benefit, and under what circumstances. This differs from a pre authorization which as you know Blue Cross will no longer do.The more you know before you commit the better for all.

Breast Reduction and Insurance Coverage?

Unfortunately, there is no way of predicting what the likelihood of postoperative approval for the breast reduction procedure will be in your case. Your best bet will be to communicate with the insurance company (in writing preferably) and obtain as much support as possible ( primary care physician, plastic surgeon…) For the need for breast reduction ( prior to undergoing the procedure). Ultimately, you may not have 100% assurance or peace of mind that the procedure will be... more

PS to do BR, but need PA for BCBS to PAY

BCBS in some states have "streamlined" pre-determinations for plastic surgery. It is a one page fill in the blank form, which will need further information before determination is rendered. I would check with your bcbs representative and see if your plan does cover for breast reductions, as this is an exclusion for some. Even if it is a covered procedure, pre-determination is not a guarantee of payment. The individual plan's criteria must be met.

Postauth for breast reduction

Some BC plans do not preauthorize surgeries. If so, you do risk a postop denial. Check your insurance criteria online to see if you will qualify. BC often wants proof of conservative management and, despite the amount of the reduction, unless you qualify as gigantomastia, I would be cautious about assuming that you will be reimbursed.