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?
Answer: Insurance coverage for breast reduction Breast reductions are usually considered medically necessary when you meet certain criteria. Each company will usually have slightly different criteria and you can usually find these on their website or can be given them by your plastic surgeons office. Most will require long standing symptoms of back, neck or shoulder pain that is documented by your primary care physician for at least 3 months. They also want to see if your PCP has tried other methods of treatment before surgery such as NSAIDs, pain meds, physical therapy or chiropractor visits and these failed to alleviate your pain for 3 months or more. They will also look for posture problems, skin rashes, numbness of your hands, shoulder grooves and more. They will also look for how many grams of tissue that can be removed from each of your breasts during surgery. Each company has a sliding scale based on your body surface area called the Schnur scale and usually you must be above the 22nd percentile for grams of tissue to be removed in order to qualify. These should get you started, Good Luck!
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Answer: Insurance coverage for breast reduction Breast reductions are usually considered medically necessary when you meet certain criteria. Each company will usually have slightly different criteria and you can usually find these on their website or can be given them by your plastic surgeons office. Most will require long standing symptoms of back, neck or shoulder pain that is documented by your primary care physician for at least 3 months. They also want to see if your PCP has tried other methods of treatment before surgery such as NSAIDs, pain meds, physical therapy or chiropractor visits and these failed to alleviate your pain for 3 months or more. They will also look for posture problems, skin rashes, numbness of your hands, shoulder grooves and more. They will also look for how many grams of tissue that can be removed from each of your breasts during surgery. Each company has a sliding scale based on your body surface area called the Schnur scale and usually you must be above the 22nd percentile for grams of tissue to be removed in order to qualify. These should get you started, Good Luck!
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Answer: What would qualify as medically necessary for a breast reduction? I am sorry to hear about the problems your disproportionately large breasts cause. There is nothing in your description that makes me think that you would be at greater risk of denial of breast reduction surgery coverage by your health insurance company. On the contrary, based on your description, you sound like you may be an excellent candidate for breast reduction surgery; of course, much more information is necessary to provide you with definitive advice
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Answer: What would qualify as medically necessary for a breast reduction? I am sorry to hear about the problems your disproportionately large breasts cause. There is nothing in your description that makes me think that you would be at greater risk of denial of breast reduction surgery coverage by your health insurance company. On the contrary, based on your description, you sound like you may be an excellent candidate for breast reduction surgery; of course, much more information is necessary to provide you with definitive advice
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October 9, 2015
Answer: What makes a breast reduction medically necessary Each Insurance company is going to have their own criteria for this. Some of these are back pain, neck pain, shoulder pain, breast pain, bra strap grooving, intertrigo, postural changes, and others. Perhaps most importantly, they have tables which match your body surface area to expected excision weight. If the surgeons best estimation is that he will remove a certain weight from each breast, and this falls under the company guidelines, you will usually be approved.
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October 9, 2015
Answer: What makes a breast reduction medically necessary Each Insurance company is going to have their own criteria for this. Some of these are back pain, neck pain, shoulder pain, breast pain, bra strap grooving, intertrigo, postural changes, and others. Perhaps most importantly, they have tables which match your body surface area to expected excision weight. If the surgeons best estimation is that he will remove a certain weight from each breast, and this falls under the company guidelines, you will usually be approved.
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October 8, 2015
Answer: Breast reduction insurance requirements Insurance companies are becoming more and more restrictive that many women with overlarge breasts and are suffering from systemic pain and discomfort are excluded. Fortunately, you can always make an appeal if your claim has been denied.The first step is to find a board-certified plastic surgeon who specializes in breast reduction surgery because his staff is well-verse when it comes to the insurance application process. They can also present the proper documentation proving that your operation is not just cosmetic, but a medically necessary procedure that will improve the quality of your life. Take note that each issuer has their own requirements, although the list below shows the most common ones:* Amount of breast tissue to be excised. For instance, many health insurance issuers require at least 500 grams (per breast) of removed tissue before they cover the surgery's cost. * Breast size relative to the body. This means that your height and weight are taken into account. This is advantageous for petite women because even smaller reductions could be covered with this kind of arrangement.* Tried other non-surgical treatments. They may ask you to try therapy or weight loss first before they agree to cover the cost of breast reduction.Good luck and best wishes.
Helpful
October 8, 2015
Answer: Breast reduction insurance requirements Insurance companies are becoming more and more restrictive that many women with overlarge breasts and are suffering from systemic pain and discomfort are excluded. Fortunately, you can always make an appeal if your claim has been denied.The first step is to find a board-certified plastic surgeon who specializes in breast reduction surgery because his staff is well-verse when it comes to the insurance application process. They can also present the proper documentation proving that your operation is not just cosmetic, but a medically necessary procedure that will improve the quality of your life. Take note that each issuer has their own requirements, although the list below shows the most common ones:* Amount of breast tissue to be excised. For instance, many health insurance issuers require at least 500 grams (per breast) of removed tissue before they cover the surgery's cost. * Breast size relative to the body. This means that your height and weight are taken into account. This is advantageous for petite women because even smaller reductions could be covered with this kind of arrangement.* Tried other non-surgical treatments. They may ask you to try therapy or weight loss first before they agree to cover the cost of breast reduction.Good luck and best wishes.
Helpful
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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