How to get preauthorized documentation for breast reduction?

I talked to my ins & they said they would cover, but follow the steps provided. So, I do have 36G/H and suffered from back, neck, shoulder pain since 15 yrs old. I am 157lbs 5'5. They droop & are heavy. Ive had headaches for quite sometime & seen docs about it. So what how do I get my chiro to recommend a reduction when I go? Ive generally seen orthos & they only prescribed meloxicam. Do I ask for recommendation when I see them?

Doctor Answers 3

Insurance to cover Breast Reduction

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You need to see a Board Certified Plastic Surgeon,that takes your insurance.  They will take photos of you at the appointment and get the documentation to submit to the insurance co. Even though the insurance co says you are approved for the Breast Reduction they may have a sliding scale as to how much they have to take off.  I am doing a breast reduction tomorrow and the insurance co required 1000 grams per each side!  This patient still would like.breast after the surgery- she is paying for the surgery herself

Salt Lake City Plastic Surgeon

How to get preauthorized documentation for breast reduction?

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Thank you for the question and congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. Based on your description, it sounds like you may be an excellent candidate for the procedure. 
Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, 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. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform.
Also, prepare to be persistent when dealing with health insurance companies. I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.

Prior Authorization for Breast Reduction Surgery

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Although insurance carriers may differ in their requirement most will judge their approval on the following: 
  1. Your height and weight
  2. Your Cup size
  3. Your Symptoms
  4. Conservative measures that you have employed over the past year to improve your symptoms
Your surgeon will then provide on your behalf: 
  1. Your photograph
  2. The anticipated amount of tissue from each breast to be removed
  3. Finding on your physical exam.  deep bra creases, measurement etc.   Good Luck

Joseph Rucker, MD, FACS
Eau Claire Plastic Surgeon
4.7 out of 5 stars 22 reviews

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.