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What's the Likelihood of HMO Illinois Covering 34DD Breast Reduction?

asked 9 months ago by lilaahhh in Naperville, IL
Latest answer by Tom J. Pousti, MD
Question viewed 1,560 times
Tags: DD cup, insurance

Hi! I'm 5'3", 135 lbs (lots of muscle) with 34DDs, and I want a reduction. I have trouble with my breasts (back/shoulder pain), but especially while running. Breathing is very difficult since I already have asthma, and the sports bras I have to wear + back tightness makes things awful. I'm wondering if these criteria are 'enough' to get approved, or if anyone knew the HMO Illinois systems particular regulations? What size would an insurance-approved reduction bring me down to? Thanks!

8 answers to What's the Likelihood of HMO Illinois Covering 34DD Breast Reduction?

+2

HMO coverage for breast reduction

HMO Illinois has a very good record for coverage for breast reduction, better than the PPO plan in our area. If your primary supports the referral the chances are very good that the plan will allow breast reduction. Best of luck, peterejohnsonmd
Peter E. Johnson, MD

Chicago Plastic Surgeon
+1

Breast Reduction Insurance Coverage?

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. It is one of the most patient pleasing operations we perform. Based on your description you may be a good candidate for breast reduction surgery; for physical and emotional reasons. The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care... more
Tom J. Pousti, MD

San Diego Plastic Surgeon
+1

Will my insurance approve my breast reduction?

In order to approve a breast reduction, insurances will look at medical records supporting symptoms of back pain, neck pain, shoulder grroving, shoulder pain, and recurrent skin rashes. It is very importatn to have these symptoms well documented by your primary care physician who should then refer you to a board certified plastic surgeon who is a provider for your insurance. The plastic surgeon will then submit the documentation, photos, measurements, and a letter of medical necessity.... more
Frank Agullo, MD

El Paso Plastic Surgeon

www.elpasoplasticsurgery.com

+1

What's the Likelihood of HMO Illinois Covering 34DD Breast Reduction?

You need to see in plan boarded PS in that HMO. He than can write a letter of predetermination to the HMO with your photos to obtain an OK. Each insurance company has their own citeria for approving breast reduction as a covered benefit. It is a "process". Best of luck
Darryl J. Blinski, MD

Miami Plastic Surgeon
+1

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... more
George J. Beraka, MD

Manhattan Plastic Surgeon
+1

Obtaining coverage for breast reduction surgery from insurance company

As Dr. Marosan noted, you need to ascertain whether your particular insurance plan does cover breast reduction surgery. If it does, you should seek a consultation from a board certified plastic surgeon in your area who could examine you and determine whether it would be likely that you may be able to obtain approval for insurance coverage of the procedure. He/she could also then submit your information. Your symptoms are helpful in fulfilling criteria for coverage. Often, a certain... more
Steven Turkeltaub, MD

Scottsdale Plastic Surgeon

www.turkeltaub.com

+1

Insurance criteria for Breast Reduction surgery

Hi, Most insurance companies require at least 500g per breast to be removed which approximately corresponds to 2.5 cup sizes. This may be too small for your frame. What I usually recommend is for patients like you who are not that large to finance the reductions themselves so that you are not unhappy with your results. Another point I'd like to emphasize is that there is a new technique for reducing breasts that not only makes them smaller, but the weight of the breast mound is... more
Gary M. Horndeski, MD

Houston Plastic Surgeon

www.horndeski.com

+1

Insurance coverage for breast reduction

You need to look at your contract with the HMO or call them to see if btreast reduction is one of the surgeries they cover and what are their criteria if symptoms, weight removal and or second opinion requirement for an orthopedic evaluation, physical therapy and so on. Insurance co. place more and more restrictions so more people will get discouraged with the process. Good luck.
George Marosan, MD

Bellevue Plastic Surgeon

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