Fidelis care and breast reduction?

Question

Hi, I got on a call with two surgeons in NYC about breast reduction, but both told me they don't "work" with state insurances. I have a Fidelis essential care plan 4 and really want to get this surgery done. I have a BMI of 22 and cup size DD, I've struggled with neck and back pain for years, but have seen doctors for that abroad and want to know what is the procedure to get approved, and any recommendations for clinics/doctors that accept the insurance plan I have?

Daniel Barrett, MD · Answer

Dear kaliakria,
if you have a well documented history of health issues caused by your breasts, then there is a chance that your insurance will cover the costs. Finding the right Dr. is extremely challenging especially with the number of online platforms and resources available. There a lot of great Dr's available. Make sure he/she is a board-certified plastic surgeon. Definitely check to make sure your choice specializes in the procedure you want and spend the time to read through patient testimonials. There is a number of different sites where you can check for reviews (Realself, yelp, google, etc.).You can always pick up the phone and call around also, find an office you feel comfortable with and set up a few consultations. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

Fidel is is like Medicaid for New York. Your best bet is to consult with plastic surgeons who work at a university they are more likely to agree to perform your procedure.

Camille Cash, MD · Answer

Breast reduction coverage varies by insurance policy, as do the criteria to have it approved.  I encourage you to start by speaking directly with your insurance carrier to see which board certified plastic surgeons they have relationships with for this coverage.  You can then schedule a few consultations to learn more about the procedure.

Robert L. Kraft, MD, FACS · Answer

Fidelis started as a Medicaid provider and is now actually the largest insurer in NYS.  Your BMI makes you eligible but you also have to meet the gram weight requirements and conservative management regulations.  Fidelis is quite reasonable to work with as compared with other carriers.  My staff has a lot of experience in dealing with their preauthorization process. Best wishes.

Csaba L. Magassy, MD (in memoriam) · Answer

You just have to be diligent and find a Plastic Surgeon that is willing to participate with your insurance company...

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