I called my insurance company and explained that I have a long history of back pain and migraines due to my large breasts. they explained to me that back pain and such is not considered medical that it would be a cosmetic procedure. are they right is back pain a cosmetic thing?
October 8, 2015
Answer: What would qualify as medically necessary for a breast reduction? Thank you for your excellent question, and I am sorry to hear about your back pain and migraine issues from your large breasts. Each insurance carrier will have specific criteria that their members will be required to meet in order to have a breast reduction considered medically necessary. Typically, insurance companies will require 3-6 months worth of documentation from your primary care provider of breast-related symptoms (rashes, neck/back pain, and shoulder grooving), and treatment failures (weight loss, physical therapy), that have led you to pursue surgery. Once approved, the insurance companies will determine either a fixed amount of breast tissue, or an amount proportional to your height, that needs to be removed in order to have the operation covered by insurance. Hope that this helps.
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October 8, 2015
Answer: What would qualify as medically necessary for a breast reduction? Thank you for your excellent question, and I am sorry to hear about your back pain and migraine issues from your large breasts. Each insurance carrier will have specific criteria that their members will be required to meet in order to have a breast reduction considered medically necessary. Typically, insurance companies will require 3-6 months worth of documentation from your primary care provider of breast-related symptoms (rashes, neck/back pain, and shoulder grooving), and treatment failures (weight loss, physical therapy), that have led you to pursue surgery. Once approved, the insurance companies will determine either a fixed amount of breast tissue, or an amount proportional to your height, that needs to be removed in order to have the operation covered by insurance. Hope that this helps.
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October 9, 2015
Answer: Insurance coverage Every insurance carrier and plan is different but, in general, they won't approve a breast reduction for things that they can't measure, like pain. They will approve a reduction, unless it is a contractual exclusion, for things that they can measure. For example, if a surgeon well remove 600 grams of breast tissue on a woman who isn't morbidly obese. Your plastic surgeon can help you determine if you can get insurance coverage for a breast reduction with you specific plan.
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October 9, 2015
Answer: Insurance coverage Every insurance carrier and plan is different but, in general, they won't approve a breast reduction for things that they can't measure, like pain. They will approve a reduction, unless it is a contractual exclusion, for things that they can measure. For example, if a surgeon well remove 600 grams of breast tissue on a woman who isn't morbidly obese. Your plastic surgeon can help you determine if you can get insurance coverage for a breast reduction with you specific plan.
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