I am 29 and 5"3 and weigh 140 lbs. I push out of a 34dd and would like to go down to a 34 full b/c. I have gone through two pregnancies/nursing and am now done. I have waited the 7 mo post nursing and have lost all the weight and then some. I have BCBS of NJ ppo and would like them to cover surgery as I cannot alone. I have documented with past ob/gyns the neck/back pain and headaches. Any words of advice to make this go smoothly with insurance. (live in NV with surgeons in ntwrk)
Answer: Insurance coverage for Breast Reduction
If you have documented symptoms of back pain, neck pain, shoulder pain related to large breasts, insurance may cover your breast reduction. You need to see a plastic surgeon who is on your insurance plan for maximum benefit. During your consultation and exam, your doctor will let you know whether or not you are good candidate to have this done and be covered by insurance. A preauthorization from your insurance company, however, is no guarantee of payment, so be prepared for some financial obligation.
Helpful 1 person found this helpful
Answer: Insurance coverage for Breast Reduction
If you have documented symptoms of back pain, neck pain, shoulder pain related to large breasts, insurance may cover your breast reduction. You need to see a plastic surgeon who is on your insurance plan for maximum benefit. During your consultation and exam, your doctor will let you know whether or not you are good candidate to have this done and be covered by insurance. A preauthorization from your insurance company, however, is no guarantee of payment, so be prepared for some financial obligation.
Helpful 1 person found this helpful
Answer: Insurance coverage of breast reductions Every insurance company is different depending on the plans that you have. In general, insurance companies want you to have documented that you have had back pain for some time. Then they want you to have tried conservative treatment (therapy, chiropractor, and pain medications.) Then based on your height and weight, they determine how much breast tissue has to be taken off to cover the procedure. Consult with a board certified plastic surgeon, they will help you through the process.
Helpful
Answer: Insurance coverage of breast reductions Every insurance company is different depending on the plans that you have. In general, insurance companies want you to have documented that you have had back pain for some time. Then they want you to have tried conservative treatment (therapy, chiropractor, and pain medications.) Then based on your height and weight, they determine how much breast tissue has to be taken off to cover the procedure. Consult with a board certified plastic surgeon, they will help you through the process.
Helpful
August 2, 2014
Answer: Insurance coverage of breast reduction? Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance. Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. Typically a description of your complaints as well as a detailed examination, measurements, estimate of weight removed, and photographs will be required. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!
Helpful
August 2, 2014
Answer: Insurance coverage of breast reduction? Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance. Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. Typically a description of your complaints as well as a detailed examination, measurements, estimate of weight removed, and photographs will be required. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!
Helpful
September 17, 2011
Answer: Breast reduction insurance coverage
Based on your description you may be a good candidate for breast reduction surgery; for physical and emotional reasons.
The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you're working with a well-trained/experienced board-certified plastic surgeon.
Good luck!
Helpful
September 17, 2011
Answer: Breast reduction insurance coverage
Based on your description you may be a good candidate for breast reduction surgery; for physical and emotional reasons.
The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you're working with a well-trained/experienced board-certified plastic surgeon.
Good luck!
Helpful
December 12, 2010
Answer: Breast reduction insurance coverage
Your best bet is to find a participating surgeon and go in for a consultation and have a predetermination of benefits letter composed to ascertain your level of coverage.
Helpful
December 12, 2010
Answer: Breast reduction insurance coverage
Your best bet is to find a participating surgeon and go in for a consultation and have a predetermination of benefits letter composed to ascertain your level of coverage.
Helpful