Denied breast reduction even though plastic surgeon estimated removal of 1000 g off each breast.

Question

Hi today I was denied my insurance BCBSNC will not be covering my breast reduction surgery. I'm not even sure what size I am I'm thinking I'm an I at this point . I provided all documentation I thought except a letter from the chiropractor. When I visited my plastic surgeon office I was told my breast were very dense and estimated a total of 1000 g of fat off each breast. My question is what do I need to do now to appeal and hopefully make my insurance pay for it??

Scott C. Lindsay, DO · Answer

Hello, thank you for your recent question.  Each insurance company has there own guidelines and what they will allow to be removed this is out of our hands.   You should be getting a denial letter in the mail from the insurance company its self.  Once you get this letter there will be instructions on how to start the appeal.  Best of luck!

Michael Meininger, MD · Answer

Sorry about the difficulty you are having getting your breast reduction to be covered by your insurance.  The denial can be due to multiple reasons.  Most insurances require a certain amount of tissue be removed (which in my opinion you obviously meet), however, they also require documentation from medical professionals, such as your PCP, Internist and/or Chiropractor that you have been under their care for a certain amount of time, typically six months to one year, for back, neck, shoulder pain, shoulder grooving and/or intertrigo (rash under breasts from skin to skin contact) that has been refractory to conservative treatment.  Even though you provided the documentation they requested, you might not have met their criteria of conservative treatment.  The insurance coordinator from the physician's office can instruct you on how to appeal the authorization or what information may be missing.  There is also the possibility that breast reductions are an exclusion of your insurance plan and will not cover breast reductions even if you are the perfect candidate.  If that is the case you still wished to proceed, it would be considered a cosmetic procedure.  Good luck, and I hope you are able to get the denial overturned.

Steven Wallach, MD · Answer

I suppose you can try an appeal, if not and you want the surgery, you will have to self-pay.........

Denied breast reduction even though plastic surgeon estimated removal of 1000 g off each breast.

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