Who do I see first for getting started on Breast Reduction & insurance coverage (gateway health plan)?

Question

OBGYN, Reg Dr. Or chiropractor?

Miguel Delgado, MD · Answer

For your specific health plan you might want to start by contacting them, insurance companies have different plans. Is it an HMO or PPO? You might have to use a doctor that is in their plan, or you may find out that breast reduction surgery is excluded on your policy. If you find out that it is a covered procedure and you can pick any doctor you want, then find a Board Certified Plastic Surgeon that specializes in breast surgery, and that surgeon will be able to advise you to what is needed in order to get approval. If you meet the insurance companies guidelines, don't get discouraged if you get turned down, ask your surgeon to appeal your case...I have gotten many patients approved this way. Good luck!

Marcus L. Peterson, MD · Answer

In order to qualify for a breast reduction by your insurance company you need to prove that you have symptoms related to your large breasts.  Try to assess what problems your large breasts give you and seek care from your primary care provider.  This documentation will be important.  You may need a trial of physical therapy and or other orthopedic evaluation for back pain.  If no other reason for you symptoms are found then your insurance company may approve you.Best WishesDr. Peterson

Steven Wallach, MD · Answer

In the past, back in the "better days" of medicine, you would actually be able to go to the plastic surgeon and your insurance company would pay for the surgery. Today, you need tons of documentation to prove to yoru insurance company that you need a reduction.  That requires notes from your medical ,ob/gyn, chiropractor, or orthopedic surgeon.

Joseph Rucker, MD, FACS (retired) · Answer

Would suggest that you first call your insurance carrier and see which Board Certified Plastic Surgeons are available within you plan.  Next set up an appointment for an examination:  During the consultation the surgeon will determine: The amount of Tissue to be removed relative to height and weight (most patients go from a D or DD cup to a C cup)He or She will take a history of symptoms caused by condition:back problems 2.neck strain 3. bra strap irritation 4. rashes beneath breastAlso, a history of  you trying to improve symptoms with conservative methods:Physical therapy, oral medication, massage etc.A letter is then sent for prior authorization by your physician, with the above information included.Good Luck

Who do I see first for getting started on Breast Reduction & insurance coverage (gateway health plan)?

Answers (4)

Answer: What is the Process For Seeking Insurance Coverage For Breast Reduction

Answer: What is the Process For Seeking Insurance Coverage For Breast Reduction

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Everything you need to know about Breast Reduction

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Who do I see first for getting started on Breast Reduction & insurance coverage (gateway health plan)?

Answers (4)

Answer: What is the Process For Seeking Insurance Coverage For Breast Reduction

Answer: What is the Process For Seeking Insurance Coverage For Breast Reduction

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.