Breast Reduction: Q&A

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Insurance Denied My Operation- What Can I Do?

I was denied from my insurance because they do not agree with my doc who wants to remove 700g from each of my breasts. They said according to the schnur's criteria. It states it should be 1070 removed. Am I to fat and need to lose weight to get this approved? What so I have to do to get this approved. I have severe neck and back pain that i have suffered for years. With other issures. Im 44 years old and wieght 241 lbs and is 5feet 10 inches tall.

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4 Doctor Answers | Asked by Paula R in Baraboo
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Insurance denial for Breast Reduction Surgery

Each insurance company is different with what they require to "authorize" the breast reduction surgery through insurance. I write a letter and send photos of the patient when trying to get authorization (I am sure most plastic surgeons do this as well). Also getting supporting letters from other doctors who can document that you have had neck, back and shoulder pain and/or rashes due to the large breasts. Supporting documentation is usually very helpful. If you... more
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Insurance appeal for denied breast reduction

If you are denied for breast reduction, there is an appeal process you can file with your carrier. Your doctors estimate is only that, and Schnur's criteria are dated and are a single opinion of modest medical evidence which are used to support insurance denials. If you are in a large work place or a union, also contact your benefits administrator to call on your behalf. Best of luck, peterejohnsonmd
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You can appeal your insurance company or complain to the board of insurance

Sorry to hear that your insurance company has denied your coverage for breast reduction. It seems like you are a good candidate for the procedure and would benefit alot from it. Having been denied coverage for your surgery, you can appeal the decision, you can complain to the state board of insurance, or you can pay for the procedure yourself. Good luck.

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Insurance Denied My Operation- What Can I Do?

Regarding: " I was denied from my insurance because they do not agree with my doc who wants to remove 700g from each of my breasts. They said according to the schnur's criteria. It states it should be 1070 removed. Am I to fat and need to lose weight to get this approved? What so I have to do to get this approved. I have severe neck and back pain that i have suffered for years. With other issures. Im 44 years old and wieght 241 lbs and is 5feet 10 inches tall." When you or... more
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Comments (1)

I had alot trouble getting a proved also. I just stuck with it and jumped thru hoops and keep appealing...it took three times and they finally approved! so keep standing your ground and bug the crap out of the insurance company. good luck
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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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