Where do I start with the breast reduction process, as far as getting it covered by insurance? (Medcost)

Thank you for you question,         The Bellesoma Method is a current technique to lift and/or reduce breasts without using implants or the ugly vertical scars.  The incisions are hidden around the areola and in the inframammary crease. The vertical incision has been completely eliminated. The areola incision heals almost invisibly due to the fact that there is hardly any tension on the closure. With this particular technique, ducts are preserved along with nerve supply maintaining nipple sensation and the ability to breast feed. Because the breast is reshaped internally and is secured to your chest muscles, upper pole fullness is possible without an implant. Attached is a patient who underwent The Bellesoma Method. Please note that her tissue was used to create upper pole fullness and cleavage without any foreign materials (mesh, implants, etc).  Unfortunately, we do not accept insurance for breast reductions.  Dr. Horndeski does not remove enough breast tissue to meet insurance criteria.  Instead, he utilizes the breast tissue to reshape the breast.  It is a proprietary technique that only surgeons that have been trained by me can perform. I hope this helps. Best wishes and kind regards, Dr. Gary Horndeski

Hello! your. best bet is to contact your insurance company and speak to someone in member benefits. They will be able to assist you in determining what is required for coverage. Once that is determined, schedule consults with board certified plastic surgeons to learn about the procedure! Good luck!

Check with your insurance carrier to determine if 1) policy covers breast reductions (many policies now write breast reductions completely out of coverage) and 2) if they do cover,  what they require in terms of documentation (back aches, shoulder pain, headaches, etc) before they will approve a surgery.A board certified plastic surgeon in your area should be familiar with the process of submitting a pre-determination of benefits..

I recommend you contact your insurance carrier to see what benefits you have and how to proceed. There are likely in network physicians that they can refer you to. Best wishes. 

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.  
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.  Best wishes.

Each insurance company is different and you have to check with yours regarding their coverage requirements. Then, seek a consultation with a plastic surgeon. Good luck!

Insurance coverage for breast reduction is becoming increasingly difficult. First, check with your insurance company to understand your plan's criteria for coverage. Second, consult your primary physician. Some insurance companies require that you attempt other methods to correct your functional concerns before surgery. Once these other means have been tried, your primary physician will write a letter indicating that the procedure is medically necessary. Third, choose a plastic surgeon in your network, and determine if the amount of breast tissue that is to be removed meets your plan's requirements. Four, hope that your insurance company will act appropriately in its coverage.

Hello and thank you for your excellent question. I suggest that you call your insurer, to find out what their requirements are for coverage of a breast reduction. Of course, you will need an in-person consultation to evaluate you for this procedure. Preoperative visualization and surgical simulation with the Crisalix system may help with your decision. I suggest that you find a board-certified plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of patients who have had similar procedures. Good luck!
Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc”