I am 17 years old and I weigh 130 pounds. I am 5'3" and have a 38 F/G bust. I want to get a breast reduction but my insurance say "patients are generally female and at least the age of 18". Because I am a year below this, will it effect the approval of this surgery? I have chronic neck and back pain and have quite a difficult time doing everything because of my breasts. I really want the surgery done now, so do you think my insurance would cover it? What should I do to get covered, what doctors should I see? My health insurance is Boston Health Net Plan. Thanks!
Answer: Breast reduction insurance coverage
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 saying a well-trained/experienced board-certified plastic surgeon. Good luck!
Helpful
Answer: Breast reduction insurance coverage
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 saying a well-trained/experienced board-certified plastic surgeon. Good luck!
Helpful
February 17, 2010
Answer: Breast reduction under 18 Your best option is to seek the evaluation of a board certified plastic surgeon and have them prepare a letter of predetermination of benefits letter to your insurance carrier to ascertain coverage. This will best answer your question whcih in my opinion should be covered.
Helpful
February 17, 2010
Answer: Breast reduction under 18 Your best option is to seek the evaluation of a board certified plastic surgeon and have them prepare a letter of predetermination of benefits letter to your insurance carrier to ascertain coverage. This will best answer your question whcih in my opinion should be covered.
Helpful
Answer: Insurance coverage requirements
Every insurance plan has their own unique criteria on whether they will cover a breast reduction. 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. Basu
Houston, TX
Helpful
Answer: Insurance coverage requirements
Every insurance plan has their own unique criteria on whether they will cover a breast reduction. 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. Basu
Houston, TX
Helpful
August 13, 2013
Answer: Insurance and breast reduction
Reductions can be done as early as 15 with parental consent, a proper medical clearance and breast growth that has stopped. Insurance coverage is a hit or miss depending on the carrier. Usually having symptoms related to breast size is necessary for insurance coverage. Getting it covered though is very difficult. Insurance companies wont tell anyone how much tissue needs to be removed to qualify for coverage. Then if the surgeon is 1gram off they deny coverage after the fact. Insurance companies make money by denying coverage. For that reason most plastic surgeon will likely ask for payment up front. Breast reductions are the most gratifying operations because years of neck, back and shoulder pain are gone within days. The final size result depends on your starting size. If you start larger then you will likely end larger. It is not possible to choose a size with any real accuracy. The main reason is that the procedure removes breast tissue but leaves enough tissue to preserve the blood supply to the nipple and areola. Thus more tissue needs to be left behind to ensure nipple viability. The nipple and areola is constantly being accessed during the operation. See a board certified plastic surgeon for specifics on your treatment.
Helpful
August 13, 2013
Answer: Insurance and breast reduction
Reductions can be done as early as 15 with parental consent, a proper medical clearance and breast growth that has stopped. Insurance coverage is a hit or miss depending on the carrier. Usually having symptoms related to breast size is necessary for insurance coverage. Getting it covered though is very difficult. Insurance companies wont tell anyone how much tissue needs to be removed to qualify for coverage. Then if the surgeon is 1gram off they deny coverage after the fact. Insurance companies make money by denying coverage. For that reason most plastic surgeon will likely ask for payment up front. Breast reductions are the most gratifying operations because years of neck, back and shoulder pain are gone within days. The final size result depends on your starting size. If you start larger then you will likely end larger. It is not possible to choose a size with any real accuracy. The main reason is that the procedure removes breast tissue but leaves enough tissue to preserve the blood supply to the nipple and areola. Thus more tissue needs to be left behind to ensure nipple viability. The nipple and areola is constantly being accessed during the operation. See a board certified plastic surgeon for specifics on your treatment.
Helpful
June 18, 2013
Answer: Insurance coverage for a teenager for a breast reduction
It is certainly possible that a teenager would be a candidate for a breast reduction. If the breast are excessively large and disproportionate to your body size and are causing neck back and shoulder pain. All insurance plans are different about qualifying for coverage.
Helpful
June 18, 2013
Answer: Insurance coverage for a teenager for a breast reduction
It is certainly possible that a teenager would be a candidate for a breast reduction. If the breast are excessively large and disproportionate to your body size and are causing neck back and shoulder pain. All insurance plans are different about qualifying for coverage.
Helpful