I Was Recently Denied For A Breast Reduction Through BCBS. I Am Appealing, But Am I Wasting My Time?

Insurance approval for breast reduction can be frustrating. BCBS has a relatively straightforward checklist of things that they want to see for approval. In general, if you meet all of the requirements, approval for surgery comes quickly. But if there is one element missing, it quickly is denied. That does not mean that an appeal will be futile. It just means that more explanation needs to be offered as to why the procedure is still necessary. I have done several peer to peer reviews for patients and have found the representatives for BCBS to be very understanding. I would suspect that if you have your documentation of back and neck pain and or intertrigo in order, the absoulte volume requirements can be talked through with an appeal. And I can also say that if you are able to proceed with the procedure, you will be extremely glad that you did all that you could to make it happen. (even if it means paying out of pocket.)

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