I was wondering how likely it would be for insurance to cover a breast reduction for me. I'm 5'6", 135 pounds, and a 32g. I have chronic back and neck pain. Where my back and neck connect will frequently go numb if I am standing for long periods of time. Also, if insurance were to cover a breast reduction, how much would the doctor be required to remove. Ideally, I'd like to be a full C cup. Who's this be possible?
April 28, 2015
Answer: Insurance and breast reduction Everything you wrote sounds like you are a very good candidate for breast reduction surgery covered by your insurance company As long as you are non-smoking, you should be able to achieve a good outcome. Insurers differ in their requirements The best way to find out what yours requires for breast reduction surgery is to research your policy on their website The procedure code or cpt code for breast reduction surgery is 19318. The diagnosis is symptomatic macromastia icd9 code 611.1. Most insurers require a minimum amount removed based on a scale that uses your body surface area. Other things some insurers require are supporting documentation of rashes or musculoskeletal pain relief measures treated from physical therapist, chiropractor or other physician. This is part of the 'conservative measures' that insurers like to see documented before approving the breast reduction surgery Your plastic surgeon's office should help guide you through this process but a little leg work on your own will also streamline the approval process Good luck You will not regret the decision to have breast reduction surgery. The most common comment I hear from my patients is 'why didnt I get this done sooner'.
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April 28, 2015
Answer: Insurance and breast reduction Everything you wrote sounds like you are a very good candidate for breast reduction surgery covered by your insurance company As long as you are non-smoking, you should be able to achieve a good outcome. Insurers differ in their requirements The best way to find out what yours requires for breast reduction surgery is to research your policy on their website The procedure code or cpt code for breast reduction surgery is 19318. The diagnosis is symptomatic macromastia icd9 code 611.1. Most insurers require a minimum amount removed based on a scale that uses your body surface area. Other things some insurers require are supporting documentation of rashes or musculoskeletal pain relief measures treated from physical therapist, chiropractor or other physician. This is part of the 'conservative measures' that insurers like to see documented before approving the breast reduction surgery Your plastic surgeon's office should help guide you through this process but a little leg work on your own will also streamline the approval process Good luck You will not regret the decision to have breast reduction surgery. The most common comment I hear from my patients is 'why didnt I get this done sooner'.
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April 28, 2015
Answer: Insurance Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.Best wishes,Dr. BasuHouston, TX
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April 28, 2015
Answer: Insurance Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.Best wishes,Dr. BasuHouston, TX
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