Documentation of Back Problems for Breast Reduction Insurance Coverage?

Insurance Criteria for Breast Reduction Varies between Companies but recommendations from your primary care doctor, your gynecologist and the Plastic Surgeon should be enough (the more the better) without having to go to a chiropractor.
Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company. Contact your individual company and request their specific Criteria.
Insurance company favors approval for patient with functional problems like the ones you mentioned - back, neck and knee problems, bad posture, inability to  run , etc.
The more Physician recommendations for breast reduction the better - that would include your gynecologist, primary care doctor, plastic surgeon, chiropractor, etc.
Your plastic surgeon will then contact your insurance company for preauthorization.
Here is some general information however to help you :Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth).  In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities.  Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month.  Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance though insurance criteria are becoming more and more restrictive.

This can be done by your family practice or internist. You may also see physical therapist that can document this for you. This is important but what is most important is your height and weight to determine the body surface area which will determine how much breast tissue will need to be removed for this procedure to be deemed medically necessary.
Good luck.

Frequently your primary care physician or gynecologist are willing to write a course of physical therapy for management and treatment of back pain, This course of physical therapy will establish a record of back pain and the need for treatment.

Thank you for the question.

Your primary care and/or psychologist  may be helpful in documenting “back problems” and referring you to the appropriate spine specialists.  These physicians will hopefully be  covered through your insurance plan.

Based on your description the hoops you are jumping through will be worth the trouble;  breast reduction surgery is one of the most patient pleasing operations you perform.

Best wishes.

Back pain and strain is 'the' issue concerning the need for breast reduction and in the past was considered the primary indication for insurance coverage. Many insurance carriers rely on documentation of this finding in the predetermination process. The best documentation is from physical therapy, chiropractic therapy, or an evaluation note from an orthopedic or sports medicine physician. Documentation and support of the predetermination process can also come from your primary care physician, or even your OB-Gyn. Each individual carrier and plan under a particular carrier may have a different set of 'rules' to go by. Often the insurance company will share their criteria to help you prepare so it is helpful to call.Best of luck,peterejohnsonmd