Breast Reduction: Q&A
Ask a QuestionWhat is the Criteria for a Breast Reduction to Be Medically Necessary?
What degree of back and shoulder problems/pain are considered breast reduction reasons for medically necessary according to most insurance options? How much of the problem is alleviated by such a surgery?
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6 Doctor Answers |
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anon
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Insurance Companies' Criteria for Breast Reduction Surgery
Most women who qualify for insurance coverage for a breast reduction suffer from back, neck, shoulder pain, or have recurrent inflammatory conditions under their breasts. Other symptoms that may help qualify include numbness or tingling in the hands. Normally the numbness or tingling would be in addition to some degree of back, neck, or shoulder pain. Grooving in the shoulders from the weight of the breasts on the bra straps are also symptoms that may help qualify a patient...
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Will My Breast Reduction be Covered?
Whether breast reduction surgery is covered or not varies from company to company depending the policy whihc might exclude coverage for all, but extremely large breast reductions.
Typically they will request documentation of symptoms such as neck pain and back pain, and photographs, as well as a trial of physical therapy and weight loss, and an anticipated insurance mandiated minimum amout of breast tissue to be removed.
This information will be reviewed and often authorization is...
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Criteria for Breast Reduction to be Medically Necessary
Most insurance companies determine eligibility by how much tissue is to be removed, usually a minimum of 500 grams per breast. Usually a woman needs to be a DD or larger. Then the insurance company wants to know if having large breasts is causing back, neck and shoulder pain. they want to know what measures you have tried so far to relieve these symptoms, i.e. physical therapy, good support bras etc. Your surgeon will know how to request pre-authorization.Good Luck.
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San Francisco Plastic Surgeon
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Breast reduction insurance coverage
It is important to rule out other sources of neck and back pain prior to proceeding with breast reduction surgery; otherwise you may be disappointed if the symptoms persist despite having had the surgery. If your symptoms are related to large breasts then the chances that you will be please with results of surgery (and the relief of symptoms) are very high.
The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The...
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Medically Necessary Breast Reductions
Although it varies among insurance carriers, most companies require documentation of syptoms (pain in the neck, back, or shoulders and rashes on undersurface of breasts, for example). Most companies use the Schnur graph to determine the amount of breast tissue which needs to be removed in relation to body surface area. Many also require a trial of "conservative therapy" which never works in the case of true breast hypertrophy. As far as resolution of pain, many...
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Insurance coverage for breast reduction.
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...
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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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