I submitted a claim for a breast reduction and my claim was denied after not being deemed medically necessary. After completing 6 weeks of physical therapy and seeing a chiropractor I was not denied by told the surgery was a contract exclusion on my policy. I have blue cross blue shield of texas. Is there any way around a contract exclusion even if the surgery as been deemed medically necessary. I am 22 years old, 5'2 and weigh 125 with a 34DDD chest.
November 11, 2015
Answer: Getting a breast reduction covered. Breast reduction in the Chicago area can be quite difficult with some plans and insurance appeal can help, however under affordable care there are policies with an exclusion for breast reduction. This means your policy does not cover the procedure, ever. With open enrollment you can consider a switch, and we find the HMO plans easily worked through, and if you cannot change, reduction can be made affordable as an office procedure.
Helpful
November 11, 2015
Answer: Getting a breast reduction covered. Breast reduction in the Chicago area can be quite difficult with some plans and insurance appeal can help, however under affordable care there are policies with an exclusion for breast reduction. This means your policy does not cover the procedure, ever. With open enrollment you can consider a switch, and we find the HMO plans easily worked through, and if you cannot change, reduction can be made affordable as an office procedure.
Helpful
November 11, 2015
Answer: Getting a breast reduction covered when I have a contract exclusion. Any suggestions? Depending on your particular health insurance plan, breast reduction surgery may be considered a covered benefit. Some insurance carries may cover your breast reduction surgery based on the size of your breast, your body habitus, and the severity of back, neck, and shoulder pain caused by your large breast. Breast reduction surgery is generally considered a reconstructive procedure and may be covered by health insurance when it is performed to relieve these medical symptoms. Many insurers determine whether to categorize breast reduction surgery as reconstructive surgery based on the amount of tissue that will be removed. Breast reductions involving removal of small amounts of tissue may not be covered by your insurance. Similarly, some insurance plans have exclusionary clauses that do not cover breast reduction. Insurance policies vary greatly and even when pre-certification is successful it is not a guarantee of payment. It sounds like your only option at this point is to pay out of pocket or switch insurance plans.
Helpful
November 11, 2015
Answer: Getting a breast reduction covered when I have a contract exclusion. Any suggestions? Depending on your particular health insurance plan, breast reduction surgery may be considered a covered benefit. Some insurance carries may cover your breast reduction surgery based on the size of your breast, your body habitus, and the severity of back, neck, and shoulder pain caused by your large breast. Breast reduction surgery is generally considered a reconstructive procedure and may be covered by health insurance when it is performed to relieve these medical symptoms. Many insurers determine whether to categorize breast reduction surgery as reconstructive surgery based on the amount of tissue that will be removed. Breast reductions involving removal of small amounts of tissue may not be covered by your insurance. Similarly, some insurance plans have exclusionary clauses that do not cover breast reduction. Insurance policies vary greatly and even when pre-certification is successful it is not a guarantee of payment. It sounds like your only option at this point is to pay out of pocket or switch insurance plans.
Helpful