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

Question

To qualify does the treatment have to be 3 months of ongoing PT or chiropractic care, etc? Or can it be 3 months of a combination, such as seeing a chiropractor for 20 sessions (the limit of my insurance), then taking an NSAID and using a heating pad for a couple months?

	Does a self claim of use of OTC naproxen and/or ibuprofen count towards the treatment, or does a doctor have to be seen and recommend the meds?

Tom J. Pousti, MD · Answer

Thank you for the question.

	"Conservative therapy&rdquo; 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.

Guido P. Gutter, MD · Answer

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.

Steven Wallach, MD · Answer

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.

John Whitt, MD (retired) · Answer

Conservative therapy has different meanings to different insurance cos., but is essentially always a ruse to delay or avoid coverage.  PT, chiropractic care, and NSAIDS are among the treatments they refer to, but none of these nor any other "conservative therapy" will correct pain due to breast hypertrophy.

Alan M. Engler, MD, FACS (retired) · Answer

Hi Mindwhirl in Northern IN
	 

	Each insurance company is different and has different requirements before coverage would be considered for a surgical procedure.  The best thing for you to do is to work WITH a plastic surgeon you like.  You'll need that surgeon to submit a letter of proposed treatment, and you can ask him or her to help you find the answers to these questions.

	Or you can find out yourself.  Contact your insurance company and find out EXACTLY what their criteria are for covering a procedure such as this.  They should be able to give you that info - although it may take a few phone calls and a LOT of persistence.

	I hope that this helps, and good luck,

	Dr. E

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

Answers (7)

Answer: Conservative Therapy Has Different Meanings for Different Insurance Cos.

Answer: Conservative Therapy Has Different Meanings for Different Insurance Cos.

Answer: Breast Reduction - Coverage, What Constitutes "Conservative Therapy"?

Answer: Breast Reduction - Coverage, What Constitutes "Conservative Therapy"?

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Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.

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

Answers (7)

Answer: Conservative Therapy Has Different Meanings for Different Insurance Cos.

Answer: Conservative Therapy Has Different Meanings for Different Insurance Cos.

Answer: Breast Reduction - Coverage, What Constitutes "Conservative Therapy"?

Answer: Breast Reduction - Coverage, What Constitutes "Conservative Therapy"?

Browse related questions

Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.