Hi. I am 5’4, 110lb and have 32DDD sized breast. I have had back pain and visited a chiropractor a couple of times. Do you think I would qualify for a breast reduction covered by insurance?
Answer: Do I qualify for a breast reduction covered by insurance? (photo) This is a question best suited for your insurance company. Give them a call and ask what their policy is on covering breast reductions, what kind of documentation do you and your doctors need to provide and go from there.All the best,Moises Salama, MD
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Answer: Do I qualify for a breast reduction covered by insurance? (photo) This is a question best suited for your insurance company. Give them a call and ask what their policy is on covering breast reductions, what kind of documentation do you and your doctors need to provide and go from there.All the best,Moises Salama, MD
Helpful 2 people found this helpful
Answer: Breast reduction candidate Based on your clinical history and your photo, it's very likely that your insurance would cover your breast reduction, depending of course on the type of policy you have. Discuss this with a plastic surgeon and submit your case for approval.Best wishes,Dr.Bruno
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Answer: Breast reduction candidate Based on your clinical history and your photo, it's very likely that your insurance would cover your breast reduction, depending of course on the type of policy you have. Discuss this with a plastic surgeon and submit your case for approval.Best wishes,Dr.Bruno
Helpful 1 person found this helpful
June 24, 2019
Answer: Breast Reduction. Hello and thank you for your question.You appear to be a good candidate for breast reduction surgery. Many Insurance companies will cover this procedure.I suggest you call your company and see what criteria they require. Best of luck!
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June 24, 2019
Answer: Breast Reduction. Hello and thank you for your question.You appear to be a good candidate for breast reduction surgery. Many Insurance companies will cover this procedure.I suggest you call your company and see what criteria they require. Best of luck!
Helpful 1 person found this helpful
June 21, 2019
Answer: Breast Reduction and Insurance From your description, you sound like you would be approved for breast reduction surgery. However, it will depend on your insurance. Some policies will cover breast reduction if you meet their criteria, and other policies exclude it. Check with your HR department to find out if it is covered, or see a board certified plastic surgeon that accepts insurance and can help you get pre authorization. Good luck.
Helpful 1 person found this helpful
June 21, 2019
Answer: Breast Reduction and Insurance From your description, you sound like you would be approved for breast reduction surgery. However, it will depend on your insurance. Some policies will cover breast reduction if you meet their criteria, and other policies exclude it. Check with your HR department to find out if it is covered, or see a board certified plastic surgeon that accepts insurance and can help you get pre authorization. Good luck.
Helpful 1 person found this helpful
June 8, 2019
Answer: Do I qualify for a breast reduction covered by insurance? I am sorry to hear about the problems your disproportionately large breasts cause. Based on your picture and description you seem to be an excellent candidate for breast reduction surgery. “Typical” patients who present for breast reduction surgery are women who have disproportionately large breasts, causing problems such as neck/back/shoulder discomfort, postural changes, bra strap grooving, skin irritation/rashes under the breasts, and/or difficulty with activities of daily living and/or exercise etc. There may be both physical as well as psychosocial “stress” caused by the disproportionately large breasts. Reducing breast tissue mass and elevating the breasts on the chest wall tend to improve or alleviate many of the symptoms associated with the disproportionately large breasts. Patients considering breast reduction surgery should also consider the potential downsides (risks/complications) associated with the procedure as well. Poor scarring, for example may be associated with the procedure. Additional surgery may be necessary in the short or longer term for a multitude of reasons. When the time is right, I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons. Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done. Then, it will be important that you communicate your goals clearly with your plastic surgeon and make sure that you have realistic expectations prior to proceeding with any type of surgery. In regards to breast size desired, also communicate carefully. In my practice the use of goal pictures are helpful in this regard; a discussion of cup size can be confusing and imprecise. Therefore, I would not suggest that you communicate your goals and/or base your satisfaction with the outcome of surgery on achieving a specific cup size. I also find that the use of pictures is more helpful than the words “natural” or "proportionate” etc., which can mean different things to different people. Many of my patients choose to have enough breast tissue removed to help alleviate symptoms while retaining enough breast tissue to remain proportionate to the remainder of their torso. 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. I hope this helps.
Helpful 1 person found this helpful
June 8, 2019
Answer: Do I qualify for a breast reduction covered by insurance? I am sorry to hear about the problems your disproportionately large breasts cause. Based on your picture and description you seem to be an excellent candidate for breast reduction surgery. “Typical” patients who present for breast reduction surgery are women who have disproportionately large breasts, causing problems such as neck/back/shoulder discomfort, postural changes, bra strap grooving, skin irritation/rashes under the breasts, and/or difficulty with activities of daily living and/or exercise etc. There may be both physical as well as psychosocial “stress” caused by the disproportionately large breasts. Reducing breast tissue mass and elevating the breasts on the chest wall tend to improve or alleviate many of the symptoms associated with the disproportionately large breasts. Patients considering breast reduction surgery should also consider the potential downsides (risks/complications) associated with the procedure as well. Poor scarring, for example may be associated with the procedure. Additional surgery may be necessary in the short or longer term for a multitude of reasons. When the time is right, I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons. Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done. Then, it will be important that you communicate your goals clearly with your plastic surgeon and make sure that you have realistic expectations prior to proceeding with any type of surgery. In regards to breast size desired, also communicate carefully. In my practice the use of goal pictures are helpful in this regard; a discussion of cup size can be confusing and imprecise. Therefore, I would not suggest that you communicate your goals and/or base your satisfaction with the outcome of surgery on achieving a specific cup size. I also find that the use of pictures is more helpful than the words “natural” or "proportionate” etc., which can mean different things to different people. Many of my patients choose to have enough breast tissue removed to help alleviate symptoms while retaining enough breast tissue to remain proportionate to the remainder of their torso. 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. I hope this helps.
Helpful 1 person found this helpful
June 7, 2019
Answer: Do I qualify for a breast reduction covered by insurance? (photo) BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered by most medical insurance providers. If not, they may try to deny you based upon a lot of things such as lack of symptoms, lack of previous medical management, and lack of enough tissue that should be removed. The insurance companies will dictate the amount of tissue to be removed, not the PS. Read your medical insurance certificate of coverage. Determine what medical information is required for your medical insurance provider to issue a pre-authorization or predetermination of benefits for the BR and then work with a board certified PS who accepts your medical insurance. Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon Los Angeles, CA
Helpful 1 person found this helpful
June 7, 2019
Answer: Do I qualify for a breast reduction covered by insurance? (photo) BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered by most medical insurance providers. If not, they may try to deny you based upon a lot of things such as lack of symptoms, lack of previous medical management, and lack of enough tissue that should be removed. The insurance companies will dictate the amount of tissue to be removed, not the PS. Read your medical insurance certificate of coverage. Determine what medical information is required for your medical insurance provider to issue a pre-authorization or predetermination of benefits for the BR and then work with a board certified PS who accepts your medical insurance. Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon Los Angeles, CA
Helpful 1 person found this helpful