Should I make an appointment without a referral?

Question

I am 5"5', 120 lbs. and wear a 34D and have experienced severe neck and back pain for over 7 years. Years ago I consulted with a plastic surgeon. I was a good candidate, but ultimately it was concluded I was too young. My doctor keeps dismissing my concerns. According to BCBSNC, I meet all qualifications for insurance coverage. Will it do any harm (coverage wise) to seek a consultation without a referral?

Kevin Tehrani, MD, FACS · Answer

Depending on your insurance company, whether or not you have out-of-network benefits you may require a referral to see an in network physician.

Miguel Delgado, MD · Answer

That will depend on your insurance company and your particular policy, some require a referral and some do not. However, it certainly wouldn't hurt anything for you to have a consultation to get needed information, you may have to pay out of pocket for the consultation if the insurance requires a referral. Be sure you find a Board Certified Plastic Surgeon that specializes in breast surgery. Good luck!

Guido P. Gutter, MD · Answer

BCBS of N.C. used to have the criteria for Breast Reduction approval on their website. It appears you checked them out. I would recommend you see a Plastic Surgeon and have him examine you and advise you how to proceed to be able to undergo Breast Reduction. This even if you are out of Network and have to pay an Office Visit.  Family Physicians and other Primary Care Physicians very often do not know or appreciate the benefits of a Breast Reduction. It is true that Breast Reduction Surgery has become difficult to "get trough Insurance". That is why many of us offer Breast Reduction paid "out of pocket". Even though this sounds daunting to you consider the hassle with insurances, your "deductible" with your Insurance carrier, collecting letters of other physicians involved in your care, the possible requirements to have physical therapy for Insurance approval etc. . We may be able to offer you a quite reasonable cosmetic price for the Surgery. I know of several Plastic Surgeons in your area who can advise you. If you are troubled by your heavy breasts you will be amazed how a well executed Breast Reduction can improve your back problems, your posture and last but not least your self-confidence.Don't give up !!!

William B. Rosenblatt, MD · Answer

There will always be a disagreement between a plastic surgeon and an insurance company. Breast reductions are great surgeries. The patients are extremely happy, but the insurance companies don't like to pay. That is why I got out of all managed care plans and just make sure I do the best surgery for the patient. Good luck in your search.

Should I make an appointment without a referral?

Answers (4)

Answer: Reduction

Answer: Reduction

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.

Should I make an appointment without a referral?

Answers (4)

Answer: Reduction

Answer: Reduction

Browse related questions

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.