I am a 36DDD and I was told I did not have enough tissue to remove in order to qualify for a breast reduction covered by insurance.The surgeon told me there was a minimum requirement of 350g to be removed in order for insurance to cover and I did not meet that. She told me I would essentially need a mastectomy to meet the 350g minimum limit that insurance requests. Is the surgeon correct on telling someone with a DDD they are not big enough for a reduction? not sure what to do.
October 13, 2017
Answer: DDD and reduction If you have doubts about the assessment of your surgeon, simply seek additional opinions from other Board Certified Plastic Surgeons. Know that your agreement with your insurance company ultimately determines the criteria for coverage, and most policies are very specific about their requirements to prove that surgery is being performed for functional and not cosmetic benefits. Seek a provider willing to be your advocate.
Helpful
October 13, 2017
Answer: DDD and reduction If you have doubts about the assessment of your surgeon, simply seek additional opinions from other Board Certified Plastic Surgeons. Know that your agreement with your insurance company ultimately determines the criteria for coverage, and most policies are very specific about their requirements to prove that surgery is being performed for functional and not cosmetic benefits. Seek a provider willing to be your advocate.
Helpful
October 13, 2017
Answer: Insurance standards for reduction 350 is below the applicable standard in NY. A true DDD would get you there but the question is whether you gave substituted cup size for chest circumference. I would recommend that you see another plastic surgeon for a second opinion. The insurance company will require precertification anyway which would either confirm or rebut what you have been told. We are so underpaid for reductions that some surgeons will dissuade patients from going through insurance to convert the case to fee for service. This is such a transformational procedure that it is a pity that the insurance valuation is so absurdly low.
Helpful
October 13, 2017
Answer: Insurance standards for reduction 350 is below the applicable standard in NY. A true DDD would get you there but the question is whether you gave substituted cup size for chest circumference. I would recommend that you see another plastic surgeon for a second opinion. The insurance company will require precertification anyway which would either confirm or rebut what you have been told. We are so underpaid for reductions that some surgeons will dissuade patients from going through insurance to convert the case to fee for service. This is such a transformational procedure that it is a pity that the insurance valuation is so absurdly low.
Helpful
