Breast Reduction - Houston, TX doctor that will work with my insurance? (Cigna)

Question

I am a 19 year old female, 5'2" at 108lbs. My current breast size is approximately a 30G, though I have not been professionally measured. I've been trying to look for a surgeon that will help me in getting approved through my insurance because I'm in college and as most college students, I have no money and loans piling up... I've been having several issues since I was 13 and my breasts were getting too large for my small frame. If anybody has any recommendations, they would be highly appreciated.

Erika Sato, MD, FACS · Answer

All insurance companies are different depending on what plan you have. What you need to do is to contact Cigna and find out what coverage you have and what their rules are about "reduction mammoplasty". Typically insurance companies will have a minimum amount of breast tissue that must be removed. Aside from that, they usually want symptoms documented by more than one physician. For example, your primary care doctor and the plastic surgeon. Symptoms that they typically look for are: shoulder, neck and back pain; grooving on the shoulders from bra straps; skin rashes beneath the breasts or skin breakdown. This type of stuff would need to be documented in your medical chart. What they don't cover it for is cosmetic reasons. For instance, low self esteem or breast size out of proportion to the rest of the body. If your insurance coverage includes reduction mammoplasty, you can make an appointment with a PS and start the process to getting your breast reduction. Good luck!

Ravi Somayazula, DO · Answer

Breast reduction surgery can be a very gratifying procedure that helps patients deal with the symptoms of neck and back pain.  Insurance companies have become more strict as far as whether these procedures will be covered. They require that a certain amount of breast tissue be removed in order to even consider coverage. This is based on your height and weight. Our practice does take Cigna insurance. I would suggest seeing a board certified plastic surgeon to be evaluated for whether insurance may cover your procedure or whether a self pay option would be a better option. In the case of self pay, our practice does offer financing options that can be discussed which may be an option for you.Best wishes,Dr. Ravi Somayazula

Tom J. Pousti, MD · Answer

Thank you for the question.  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.  Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.
 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, and the attached link, helps. Best wishes.

C. Bob Basu, MD, MPH, FACS · Answer

Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.Best wishes,Dr. BasuHouston, TX

Breast Reduction - Houston, TX doctor that will work with my insurance? (Cigna)

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