I was declined by my insurance for my breast reduction? What to do?

Question

My surgeon told me he was going to take off 800 g, but his nurse stated he filed his papers that he will be taking off 797 g. Bcbs will only cover the surgery if he remove 979 g. I lost the weight to get the surgery now I can't get the surgery. I have sprung my back, I have cuts on my shoulders from my bras, now I have rashes under my breasts that bleed and smell at times. On top of that, the surgeon tells me to appeal it but he don't help with appeals...this is stupid. I don't know what to do

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Typical the surgeon's office will formally perform the appeal on your behalf.   This only makes sense because he doctor will often have a peer-to-peer (doctor to doctor) discussion about your case.  If your current surgeon doesn't or will not provide this for you then you need to find a different surgeon.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about breast reduction.You may have the surgery performed on a cosmetic basis, or you can always get a second opinion from another qualified surgeon.To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have breast reduction or related procedure.I hope this helps.

Emmanuel Mallol Cotes, MD · Answer

Thanks for sharing your concerns with us. Insurance usually doesnt cover plastics surgery. There is an option to make the procedure you want at an affordable cost, so you will not have to incur financial loans.In this regard, you have the possibility of getting a plastic surgery with high quality standards: with Board Certified Plastic Surgeons, in medical centers that follow international standards of patient safety and in comfortable and supervise recovery places after procedure, all for an affordable investment and reasonably lower than the standard values.In that sense I recommend considering coming to the Dominican Republic, its proximity to the US (45min).the "all year summer" and its political and economic stability, as a remarkable development, have made an excellent and safe destination for medical tourism and specially in Plastic Surgery, which it is already a global reference.Finally, i invite you to contact a Board Certified Aesthetic and Reconstructive Plastic Surgeon of the DR, send your photos and get the free consultation and budget: you'll see, you'll be surprised.Respectfully,Dr. Emmanuel Mallol Cotes.-

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

Tom J. Pousti, MD · Answer

I am sorry to hear about the difficult time you have had obtaining authorization. As you have found, it can be very frustrating dealing with insurance companies. I would suggest you write an appeal letter and have your physicians do the same. Look for the insurance companies' "criteria" and find as much support to meet these criteria. Be persistent.Best wishes.

I was declined by my insurance for my breast reduction? What to do?

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Answer: Insurance

Answer: Insurance

Answer: I was declined by my insurance for my breast reduction? What to do?

Answer: I was declined by my insurance for my breast reduction? What to do?

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I was declined by my insurance for my breast reduction? What to do?

Answers (10)

Answer: Insurance

Answer: Insurance

Answer: I was declined by my insurance for my breast reduction? What to do?

Answer: I was declined by my insurance for my breast reduction? What to do?

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Everything you need to know about Breast Reduction

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