Will medicare pay towards a breast reduction? I wear a triple ddd have had shoulder and back pain for years
Doctor Answers 7
Medicare and breast reductions
With Medicare you cannot do that, since they do not do preauthorizations. You should have the symptoms documents by your physician or gynecologist, as well as the board certified plastic surgeon. If the surgeon feels that there are medical indications, they can proceed with surgery. You will have to sign a waiver, so that if ultimately medicare denies the surgery as cosmetic, you will be responsible for the surgical fees.
Will medicare pay towards a breast reduction?
Based on your description you may be a good candidate for breast reduction surgery. You will do best achieving a long-term stable way prior to proceeding. 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.
You may find that working with Medicare that you will not be able to obtain “preauthorization”.
Make sure you are working with a well-trained/experienced board-certified plastic surgeon who can demonstrate significant experience achieving the types of outcomes you will be pleased with.
Medicare and Breast Reduction
Surgeon's expertise and experience
The cost for anaesthesia and operating facility
The geographic location you have the procedure
Estimates can be obtained here on RealSelf , PlasticSurgery.org or Surgery.org
Although, #BreastReduction procedures are commonly covered by #insurance and required criteria, it is becoming more and more restrictive. Some practices do not accept insurance. However, ask the staff to assist you in obtaining pre-authorization so that you can attempt to be #reimbursed for out of pocket #expenses.
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Insurance and BR
This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses
Medicare breast reduction
Due to the gamble without the preauthorization, many of us will only do very large reductions with documentation of symptoms and treatment to try to assure payment by Medicare. Even with all of that, there is no promise that Medicare will come through and the patient may be stuck with a bill. That is why many patients will opt to control their costs by going the self pay route and doing the surgery as an outpatient in a surgery center.
I have attached the criteria for consideration for breast reduction coverage below. Thank you for your question!
Medicare breast reduction
You may do better to have the surgery done by plastic surgery residents at a teaching hospital. Be sure the attending surgeon is involved. You should do well as this is the type of case that is done often.
Best of Luck
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