Keystone First denied me a breast reduction. Is there a way to get them to pay partially?

Question

Because my weight and height 120 Breast a 34D i have back neck& shoulder stress looks can be deceiving they need to be reduced my back n shoulders hurts like hell they keep denying me willing to pay out of pocket but it seem like It will take forever ..Would they pay only for me to have the anesthesia ...

Robert L. Kraft, MD, FACS · Answer

Surgery is either covered or not. The anesthesia will likely not be paid if the surgery has been denied. That doesn't mean that you can't request that the anesthesiologist provide you with a bill in a format that the insurance company can review.  The insurers have implemented strict standards to make sure that lifts aren't covered. Your photos likely do not demonstrate large enough breasts to meet the criteria.  Before the surgeon gets paid, pathology reports showing the gram weight must be submitted so there is no flexibility.

Melek Kayser, MD (retired) · Answer

I am so sorry to hear of your experience. Insurance companies vary and can often make it very difficult to provide coverage for surgery especially if they believe it is for cosmetic reasons.  There is a reduction classification system called the schnur index which correlates body mass index and provides a scale to estimate the weight of breast that is removed to meet medical criteria. Many ins companies recognize this so this may help. However, in many cases, because of deductables and co-pays, it is often less expensive to simply schedule the surgery as a cosmetic procedure in the end anyway! I hope this helps and have a wonderful day! Dr. Kayser - Detroit

Keystone First denied me a breast reduction. Is there a way to get them to pay partially?

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Keystone First denied me a breast reduction. Is there a way to get them to pay partially?

Answers (2)

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.