What are the odds of getting my Aetna HMO plan to approve a much needed breast reduction?

If anyone qualifies for breast reduction coverage under insurance, I would say that would be you.  You should contact your insurance company to find out the steps necessary to get it covered.  If you have an HMO you may need a referral to a plastic surgeon from your regular doctor.

I appreciate your question.We have to look at all of your symptoms such as the back, neck and shoulder pain as well as any skin infections you might have.From what I see, you are a great candidate and insurance typically covers this for my patients.The best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr Schwartz

Thank you for the question. Based on your description and picture, you sound like you may be a good candidate for breast reduction surgery; of course, much more information is necessary to provide you with definitive advice

Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, the more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. Also, prepare to be persistent when dealing with health insurance companies. I hope this, and the attached link, helps. Best wishes.