I am in physical therapy 2x weekly for constant neck/shoulder pain. I have numbness and tingling in my fingers. I was approved for BR surgery in October of last year. I was looking to be a C cup.In December, my insurance denied me for the procedure. They told my surgeon I needed MINIMUM 400gr removal from each side. Per my surgeon, this would likely be what I was asking for in terms of size. He attempted to explain this to my healthcare provider, BCBS, and they yet again denied me.
Answer: Bre Hi, thanks for sharing your concern and photos with us!
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Answer: Bre Hi, thanks for sharing your concern and photos with us!
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March 31, 2017
Answer: Candidate for a breast reduction ? Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
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Answer: Candidate for a breast reduction ? Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
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March 31, 2017
Answer: Breast reduction Based on your symptoms and photos, you definitely sound like a good candidate for breast reduction, although it can be difficult to know how much weight will be removed per breast and if this will meet your insurance criteria. Certainly try to see if your insurance provider will change their stance, but if they don't, I absolutely think the out-of-pocket costs for surgery will be well worth the improvement in your physical health and appearance. Good luck!
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Answer: Breast reduction Based on your symptoms and photos, you definitely sound like a good candidate for breast reduction, although it can be difficult to know how much weight will be removed per breast and if this will meet your insurance criteria. Certainly try to see if your insurance provider will change their stance, but if they don't, I absolutely think the out-of-pocket costs for surgery will be well worth the improvement in your physical health and appearance. Good luck!
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March 31, 2017
Answer: Candidate for Breast Reduction Surgery? I am sorry to hear about the problems your disproportionately large breasts have caused. Based on your description, you may be an excellent candidate for breast reduction surgery. This operation tends to be one of the most patient pleasing operations to perform.
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Answer: Candidate for Breast Reduction Surgery? I am sorry to hear about the problems your disproportionately large breasts have caused. Based on your description, you may be an excellent candidate for breast reduction surgery. This operation tends to be one of the most patient pleasing operations to perform.
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April 3, 2017
Answer: Breast reduction coverage by insurance Hi, thank you for your question. You appear to be an excellent candidate for breast reduction surgery. Getting insurance to cover breast reduction surgery is frustrating, at best. You may be able to perform a second-level appeal with your insurer (ask your surgeon if this is possible). Prior to doing so, it's best to obtain more documentation of your symptoms from an additional provider, such as a physical therapist or chiropractor. If you do need to pay out of pocket, you may be able use a financing company such as Care Credit to help spread the costs out over time.Best wishes and good luck,Dr. Naidu
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April 3, 2017
Answer: Breast reduction coverage by insurance Hi, thank you for your question. You appear to be an excellent candidate for breast reduction surgery. Getting insurance to cover breast reduction surgery is frustrating, at best. You may be able to perform a second-level appeal with your insurer (ask your surgeon if this is possible). Prior to doing so, it's best to obtain more documentation of your symptoms from an additional provider, such as a physical therapist or chiropractor. If you do need to pay out of pocket, you may be able use a financing company such as Care Credit to help spread the costs out over time.Best wishes and good luck,Dr. Naidu
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