How do I send "physical therapy documentation" for breast reduction surgery?

Question

I'm looking to have a breast reduction this summer. I visited a surgeon covered in my insurance network without a doctor's referral. I also had 14 physical therapy sessions. I called my physical therapist to ask for documentation and he's not exactly sure what I need. Do I need all 14 physical therapy notes or could a letter of support suffice? He's saying that he would give me a letter. Thanks.

Tom J. Pousti, MD · Answer

Congratulations on your decision to proceed with breast reduction surgery; it is one of the most patient pleasing operations we perform.  .
The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. 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. In your case, and letter from the physical therapist, as opposed to session notes, will likely suffice.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.  
When dealing with health insurance companies, prepare to be persistent.
Best wishes.

Alan M. Engler, MD, FACS (retired) · Answer

In general, you'll need to work with your plastic surgeon to address the specifics of your insurance policy, including whatever is required to obtain a precertification and/or prior authorization for surgery.  Most likely, the more documentation you can get, the better.  I would normally advise someone in your situation to get copies of all the notes AND a letter summarizing what you've been through.  You may also need documentation from your physician, as well as photos showing what you look like now, including bra strap grooving, and anything else that can help you "build a case."  That's essentially what you'll have to do in order to convince your insurance company to consider your procedure covered by your policy.  And I would, of course, get something in writing before proceeding with the surgery.I hope that this helps and good luck,Dr. EMember of RealSelf 100

How do I send "physical therapy documentation" for breast reduction surgery?

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How do I send "physical therapy documentation" for breast reduction surgery?

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Everything you need to know about Breast Reduction

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