Is There a Doctor in NY That Will Accept Medicaid for a Breast Reduction?
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Doctor Answers 4
Breast Reduction and Insurance Coverage?
Thank you for the question.
I would respectfully suggest that you wait until you have better “insurance coverage” or can pay fee-for-service for the procedure. You will find that revisionary surgery will end up costing you more ( financially and otherwise).
Medicaid and breast reductions
Unfortunately, most private physicians do not accept medicaid for payment of breast reductions because the reimbursement is too low. You may want to go to a plastic surgery clinic at a teaching hospital where you would ge tthe expertise of an attending plastic surgeon overseeing the education of the plastic surgery resident.
Medicaid coverage of breast reduction in NY
Unfortunately, it is nearly impossible to run an aethietci practice based on the rates that medicaid will pay. You may be able to identify a general surgeon or training program that will provide this service at these rates.
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Insurance coverage for breast reduction.
Insurance Coverage for Breast Reduction
Answer by George J. Beraka, MD
Manhattan Plastic Surgeon
80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.
1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.
2) Very big reductions (like from an F cup to a C cup) will usually be covered.
3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.
4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.
5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.
6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.
7) Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.
8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.
9) Don't give up. If the first request is denied, demand an appeal.
10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.
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.