Tips for Getting Insurance to Approve Breast Reduction?

asked 2 years ago by madam_squeak in anaheim,CA
Latest answer by Alan Engler, MD
Question viewed 2,777 times
Tags: breasts, female, 210-229 lbs, 5 ft 4 in to 5 ft 7 in, HH cup, insurance, overweight

I am 5'7" and last weighed at 210lbs, yes I know I am over weight. My bust is 40 H. I have been working out at my apartment's gym for a few weeks now. I have lost some fat and gained some muscle, and after losing some weight I gained it back without gaining the fat back (so in other words it is muscle) my natural waist is measured (this morning actually) at 34" and my bust is measured at 48", but all my doctor is concerned about is my weight. not my true body fat percentage. Any tips on how I could get my insurance approve my breast reduction?

11 answers to Tips for Getting Insurance to Approve Breast Reduction?

Breast Reduction - Insurance Coverage

It is nearly impossible to offer a guaranteed method of obtaining approval but if you have tried, and failed, a series of conservative techniques, then it may be reasonable to contact them. You'll need the help of a plastic surgeon to submit a letter of precertification (typically including your height, weight, bra size, specifics of any pain that you have and how your enlarged breasts affect your health and quality of life) and photos and to make sure that everything is set before... more

Alan Engler, MD
New York Plastic Surgeon

Insurance coverage for breast reduction

If you have H cup breasts and your insurance company considers this gigantomastia, rather than macromastia, the weight will not be an impediment to insurance approval. Every insurance company has different criteria. If your chest circumference is 48, then you may not be a 40H cup, but could be a 48 with a smaller cup size. For many insurers, the photograph will say it all. Additionally, each company has its own set of criteria. Some will require a prescribed body mass index. Others... more

Robert L. Kraft, MD
New York Plastic Surgeon

www.foresthillsplasticsurgery.com

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

Breast reduction

It is always better to lose weight to get down to a weight that is appropriate for your height. As for insurance coverage each insurance company has different criteria for approval and you would need to check with them.

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance approval for breast reduction

I recommend that you go on line and download your insurance carriers criteria for breast reduction surgery. If you do not meet these criteria, I can guarantee they will not preapprove your surgery. In general, many insurance companies will require that you have failed conservative treatment of your back, neck and shoulder pain before approving surgery. This includes no improvemnt in your symptoms with medication prescribed by your family doctor, no improvement after seeing a... more

David A. Robinson, MD
Munster Plastic Surgeon

Breast reduction insurance coverage

Breast reduction is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine. Recently, managed care has adopted stricter standards for coverage, so these problems have to be thoroughly documented in writing by your primary care physician and plastic surgeon. They may also have to submit photographs. Even then, you may be required to seek a second opinion from a... more

Michelle Copeland, MD, DMD
New York Plastic Surgeon

Insurance to approve breast reduction

TRY by seeing a boarded plastic surgeon who will then submit to your insurance company a predetermination letter with photos of your breasts. Other information will also be included. THAN IT IS A WAIT. It is like a game of who's it. Keep calling the insurance company, become a pain to them. Keep asking why, what, and when. Hopefully you will be approved.

Darryl J. Blinski, MD
Miami Plastic Surgeon

Steps for getting insurance authorization for breast reduction

If you have documented symptoms of back pain, neck pain, shoulder pain, severe grooving from your bra straps, or rashes, your insurance carrier may cover a reduction mammaplasty. Before you start the process, you should check with your insurance carrier to ensure that you don’t have a policy which excludes coverage for for breast reduction and to see if your insurance company requires a regimen of physical therapy prior to covering the procedure. Your insurance carrier may also... more

Sam Jejurikar, MD
Dallas Plastic Surgeon

Breast reduction insurance coverage

Very few insurance companies use a formula for this. BCBS tends to use a chart called the Schnur scale but they do not always adhere to its recommendations. Your best bet is to go in for a consultation and have the surgeon compose a predetermination of benefits coverage letter to your insurance carrier.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Insurance coverage for breast reduction.

Insurance Coverage for Breast Reduction Answer by. George J. Beraka, MDManhattan Plastic Surgeon80% 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... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Insurance guidelines for breast reduction surgery

Hi, The first thing you'll want to look into is your insurance company's medical policy for reduction mammoplasty or breast reduction surgery. Many insurance companies now require that you have documentation of 3+ months of conservative treatment (ie physical therapy, prescription medications, chiropractic care, etc.) tried and failed along with a mammogram and examination by a plastic surgeon with photo documentation. It is also very helpful to have letters of support from your family... more