Can You Clarify "3 Months Conservative Treatment" for Breast Reduction Insurance Coverage?

Thank you for the question.

"Conservative therapy” may be defined differently by the various insurance companies. In my opinion, this is a simple stalling  technique,  since these measures do not significantly improve patients symptoms associated with breast hypertrophy.

Unfortunately, in order to have the breast reduction covered by the health insurance company it is necessary to jump through their hoops;  it will be in your best interest to determine what the specific company's definitions are by calling them directly.

Best wishes.

As you can see from all the notes  Plastic Surgeons do not necessarily agree with this insurance "requirement".

According to the insurance(s) I tried to clarify this with, they want to see a non-operative effort of three months to treat your complains of back-, neck-, shoulder pain. A physician (it can be a primary care Doctor, Chiropractor, Orthopedic Surgeon ) who prescribes  you a  "conservative" treatment  such as Physical therapy (we use here 6 PT sessions), chiropractic manipulation etc.

After three months  if you do not have a "long lasting improvement" of your symptoms you should qualify for this particular insurance criteria.

Remember your insurance carrier is your "sponsor" and therefore they can demand certain criteria to be met before they pay for your surgery. On the other hand your Plastic Surgeon will determine if you medically benefit from a breast reduction regardless of insurance coverage or not. That means sometimes that you will have to make a decision if you want to "pay out of pocket" for the procedure.

Welcome to the world of insurance coverage for breast reductions!  Many insurance companies in the NorthEast want documentation of neck and back pain brastrap grooving or intertrigo( rashes) fro 3-6 months.  This has to be documented by the treating physicians for the given problem. Yes, I know what your are thinking.  They want to make the process laborious and difficult so that fewer people can be approved.