I want to know how long does it take for an answer?

Hi, I went to a breast specialist yesterday and I told him everything that was going on with me as far as pain and considering a BR. He said he's going to refer me to a surgeon soon and I should be able to get one. I want to know how long is the process will be before I get a answer? Is it up to the surgeon or the insurance. Also, I want to know even with all the appointments with doctors and physical therapy, could they just up and change their minds about whether I need surgery.

Doctor Answers 3

I want to know how long does it take for an answer?

I assume you are trying to get preauthorization for a breast reduction. If that is the case, then it can take a few days or many weeks, all dependent on your insurance carrier. And understand the determination has nothing to do with whether you NEED the surgery, that has already been determined by a physician. The only determination the insurance company makes is whether or not you meet their qualifications for coverage.

Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

#breastreduction #insurancecoverage

How Insurance coverage for a breast reduction is handled is dependent on the rules from your specific insurance company. Each one has rules about how they go about the pre-determination process and what  documentation they will require. (for example, physical therapy, rashes, back/neck/shoulder pain)

 A board certified plastic surgeon experienced in breast reductions should have a clear understanding of the rules for insurance carriers in which they are participating providers.

Please note that we have seen a marked decline in the number of insurance policies that will cover a breast reduction. Even if your doctor considers this medically necessary, the coverage for this surgery is written out of the policy. Your first step should be to confirm that your insurance carrier will allow for this surgery if you meet the pre-determination requirements.

Typically a physician will submit a letter of pre-determination to the carrier to confirm coverage for the surgery. This process can take anywhere from 2-6 weeks, depending on the insurance carrier review time.    

You can , of course, always proceed with a breast reduction not using insurance. A board certified plastic surgeon can give you a fee quote. If your insurance does not cover, or if you have a very high deductible, this may be a better option.

Jack Peterson, MD
Topeka Plastic Surgeon
4.4 out of 5 stars 34 reviews

The process of getting a breast reduction

Hi there,

I'm assuming your question pertains to insurance coverage for breast reduction ? If you did not worry about insurance covering it then ofcourse the process is much simpler - you see a plastic surgeon, you both agree to an operative plan and then surgery is done at a mutually convenient time.

Once insurance is involved  - the determination of meeting medically necessary criteria comes to play ! Now, this does vary slightly with each insurance, your first step would be to contact your insurance and check their criteria and if this is part of your insurance plan. Next step would be to meet with a surgeon, who will discuss the process with you and if he/she determines that you are a good candidate will then submit the documents and pictures to your insurance company . The insurance will likely also require supporting documents from your medical doctor reg. medical necessity, from physical therapist if you have had any. Once all these documents have been submitted to insurance , they may take upto 6 wks to give you an answer

Good luck !

Shwetambara Parakh, MD
Paramus Plastic Surgeon
5.0 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.