Am I Canidate for a Reduction Through Humana?

I have been reading and researching breast reduction that I do think I need, but I have noticed that insurance companies set guidlines and if you are a valid case for the reduction. I am 30 yo, done having kids, 5'10", 200 lbs and wear a size 38DD. I have suffered from migraines for about 8 yrs now. My nero dr and I decided it was muscle tension in my neck and shoulders. I also get back pain and spasms. Do you think my insurance (humana) will see me as a canidate? I'm worried I won't be.

Doctor Answers 3

Breast Reduction Candidate and Insurance Coverage

Candidates for #BreastReduction surgery are women who wish to have smaller #breasts to achieve a more proportional appearance or to alleviate physical discomfort. Breast reduction can correct symptoms from excessively #largeheavybreasts that may cause the inability to do certain exercises, or create back, shoulder and neck pain, poor posture, bra-strap shoulder indentations and chafing or rashes under the breasts. Women experiencing these discomforts may benefit from Breast Reduction, also called #ReductionMammoplasty.
Large breasts (#macromastia) or #breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive #breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual i company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process can take approximately one month to complete. 
Insurance companies have a number of requirements and an examination will be able to determine if you are a candidate for reduction. Pre-authorization by an insurance company is required prior to surgery, and the process takes approximately one month.
It may be best to see a plastic surgeon who can contact your insurance company for authorization following a #breast examination to document of your symptoms.
Also, you should also consider seeing your primary physician for an examination and documentation as well.  Although, we do not accept insurance, our staff will assist patients in obtaining a pre-authorization so they may attempt to be reimbursed for their out of pocket expenses.

Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Humana Breast Reduction Coverage

Based on your description, it sounds like you are a candidate for insuance coverage of the procedure. Consult with 2 - 3 board certified plastic surgeons who participate with humana for the best possible chance of reimbursement. They will be most familiar with the documentation requirements which generally include independent physician verification of medical necessity (i.e. imary care doctor,  neurologist, physical therapist, chiropractor etc) and documentation including letter/pictures from your plastic surgeon.  Persistance will be the key in working with insurance companies.  Generally, if you choose your surgeon well the results will make the aggravation worthwhile.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 42 reviews

Breast Reduction and Insurance Coverage?

Based on your description you may be a good candidate for breast reduction surgery; it will be in your best interests to achieve a long term stable weight prior to undergoing surgery.  

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,  neurologist, 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.  

Prepare to be persistent with the insurance  company.  Keep in mind, that breast reduction surgery is one of the most patient pleasing operations we perform.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.