47, African American, 6', 240lbs, DDD cup, are there any other options for me if insurance won't cover it?

If your insurance will mot cover the procedure there are three possible options for you. First is paying for the procedure out of pocket as a cosmetic operation. That may not be a possibility, but is always an option. The second is to find out how your insurance determines eligibility. A lot of the time weight is considered, and the more someone weighs the more they require to be removed. You could ask them what you would need to weigh in order to qualify based on the estimate that was made by your surgeon and work toward that as a weight loss goal. The third option, which may not be a reasonable option, is to consider a different insurance provider, and select one with a more generous benefit regarding breast reduction surgery.

Hello and thank you for your question.
You can try appealing the insurance company decision. If you are still denied, you can have the breast reduction as a self pay patient. Reach out to your surgeon with your concerns. Best wishes!

Unfortunately this is a pretty common occurance, fighting with insurance companies. You can appeal with the insurance company and annoy them mercilessly. You’d be surprised how the squeaky wheel gets the grease. Otherwise you can pay out of pocket and have it done in a plastic surgeons office to keep costs down. In our office surgicenter it would be no more than $15,000

If your insurance will cover the reduction then you will have to pay for it yourself. The technique I recommend is The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. The cost is $14,000.

Best Wishes,

Gary Horndeski, M.D.

This is very common, in fact, in many areas, it is hard to find plastic surgeons who take insurance even for approved breast reductions. Most plastic surgeons offer mastopexy or reduction as an out-of-pocket expense. So shop around a bit for someone offering reasonable price and perhaps offering financing options. Even patients with mostly ptosis- rather than macromastia will have significant improvement in symptoms with lifting and small reduction. Insurance companies usually make it very difficult to get coverage.

You can pay for the procedure and companies like Care Credit or Cherry can help. You can find a plastic surgery training program at a University Hospital and see if it can be done with a reduced fee. You also could get the excess fat in your breasts removed with liposuction which might decrease you in size and do a very small amount of lifting. The main problem of getting coverage from insurance companies might be your weight since insurance companies increase the amount of breast tissue that must be removed when you are over your ideal weight.

If your insurance is denying your breast reduction but you still would like to have the procedure you can consider paying for it out of pocket. There are financing companies who specialize in credit for medical procedures. Some examples include CareCredit, PatientFi, and Alphaeon Credit. See your board certified plastic surgeon to find out more.

Introduction is a very common operative procedure for plastic surgeons.

And days gone by breast production was a cover procedure in many insurance plans. Now this is a rarity. Your solution is to save a little money or perhaps finance through one of the many available financing companies.

This is a generally worthwhile operation that is a very high ultimate satisfaction rate I'll be at occasionally with some healing and scarring problems.

The first thing you should understand is that insurance compensation for breast reduction surgery is very low in comparison to what most plastic surgeons charge for doing cosmetic surgery. The difference in reimbursement compared to what surgeons charge can sometimes be a tenfold difference. There is therefore a financial incentive for plastic surgeons not to accept medical insurance for certain procedures when they have the opportunity to build a patient’s directly and make way more money. On top of this a breast reduction surgery is not a short procedure so the cost for the operating room anesthesia feet and laboratory fees are going to be substantial.
All medical insurance companies will have criteria for when surgery is covered and when it’s not. You should get a hold of your policy and find out exactly what their criteria entails. From what you describe, you sound like a perfect insurance-based breast reduction candidate and I can’t imagine too much breast tissue needs to be removed in order for you to get insurance coverage from what you describe for most insurance companies. It’s either a set amount of weight of breast tissue, or the amount of breast tissue is on a sliding scale, depending on your weight or BMI.
Typically insurance companies want us to remove about a pound or maybe a pound and a half of tissue her breast to justify this as an insurance based procedure.
From what you describe, that would still be removing only a small part of your breast.
To make sure your surgeon is being a true patient advocate, I suggest having multiple in person consultations with other providers in your community. try consulting with plastic surgeons who do a substantial amount of insurance based surgery to start with. Look for plastic surgeons to do a lot of breast cancer reconstruction. These are the providers more likely to be willing to work with your insurance company and except insurance reimbursement.
Recognize that surgeons have a financial interest in avoiding medical insurance, but this is not acting as a patient advocate
If you have medical insurance and are suffering from neck and back pain, then you deserve to have this covert procedure done without having to pay for it. The out-of-pocket cost if insurance does not cover, it will be substantial.
Be an advocate for your own rights and keep consulting until you find a plastic surgeon willing to work with your insurance company.
I wish you all the best and good luck with your breast reduction surgery. This procedure has one of the highest patient satisfaction scores of any plastic surgery operation and you’re most likely be grateful after it is complete.
Different plastic surgeons will have a different ethical standards. It’s not wrong to not accept insurance, but telling patients that they won’t have any breast tissue left may be pushing the envelope a bit far in their favor so please get a second opinion.
Best,
Mats Hagstrom, MD

You primary option if insurance will not cover the procedure is to have it done as a cosmetic procedure which would be an out of pocket cost. There are several companies that offer financing to make this a feasible option for patient ( Carecredit, Alpheon, PatientFi, Cherry)