How long does it take for the approval process?

Every insurance plan has their own unique criteria on whether they will
cover a breast reduction. Approval times vary significantly. 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

Congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. You will find that the answer to your question will differ from one plastic surgeons practice to another and from one health insurance company to another as well. Your plastic surgeon's office will likely be able to provide you with an update. Best wishes.

It is a process that is different with each insurance company.  Some can approve with a phone call, and some need multiple records from several doctors and some want 6 months of notes from back specialists.

Pre-authorization as it is called usually takes 2 to 4 weeks depending upon how long the insurance company can delay.  Also read the fine print.  Pre-authorization is not a guaranty of payment.  So if it is not a guaranty of payment then what is it? 

Its nice to expect anywhere from 30-60 days at the most and be pleasantly surprised if it comes back as early as two weeks. Most insurances rely on specifics such as pictures and meausremenst that take time to process. Wishing you all the best. If it is not covered we usually then make it fairly reasonable to have the procedure as a cosmetic case.

For most insurances, if preauthorization or predetermination is required, it usually takes 2 weeks but can take up to a month.  I suggest giving it a full month before attempting follow up.  

For breast reductions - usually it will be between 4-6 business weeks. The surgeon will submit your notes and photos and any supporting documentation to the insurance company (usually within a week or two). If you want to try to expedite that part ask the surgeon and they can usually get them submitted within a week. Then the insurance company will review it which can take between 4-6 weeks to make a determination. If they deny the procedure then you can ask for an appeal or a peer to peer review, which can take an additional week or two. After all that you may or may not be approved to proceed.Please note you can also call your insurance company directly and ask if breast reduction is covered under your plan. It is not uncommon for insurance companies to exclude breast reductions all together.

Itg takes 2-4 weeks for precertification to be approved or denied.  You can sometimes speed up the process by harassing the insurance company or your agent with daily phone calls.