I am 21 years old and weight 160 ibs im 5'2. My breast are a 38 F! I have tried to find insurance that will help me get a breast reduction, but every company tells me this is considered a pre-exsiting condition and i dont know what to do. I have very bad back pains and deep marks on my shoulders. My breast are always sore and tender because i cant find the right bra to fit me. My skin pulls very bad when i dont have on a bra so i never take my bra off. What should i do and how can i get help?
How to Find an Insurance Company to Help Me Get a Breast Reduction?
Doctor Answers 6
Breast Reduction after Insurance Company?
Thank you for the question.
Unfortunately, I do not have any specific recommendations for insurance companies; I would suggest continued persistence in your research. More than likely, you will be successful.
Hard to find an insurance company that admits coverage of breast reduction
Unfortunately, lmost no insurance company is out there for your best interests and it is rare for them to tell you this upfront. Although this is a negative opinion, it is my experience that they are in the business of rationing by hassle and will obstruct most attempts to inquire about coverage. Sorry for the downer news!
Tough call for you. Check with the insurance company that you deal with regarding criteria for approval. Everyone is different. Pre-existing conditions should not be a denial for insurance coverage.
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Insurance "coverage" of Breast Reduction
I truly sympathize with your condition but no insurance company would take you on knowing that they will spend more on you than they are likely to take in premiums. Essentially, although you have a legitimate medical expense you are asking a business in exchange for a few hundred dollars in premiums to agree to pay several thousands within the first year of your membership. If you owned a car insurance company, would you agree to sell a retroactive policy to a driver who came into your office with a recently heavily damaged vehicle he wants to repair at your expense? THAT is the purpose of the pre-existing clause with insurance companies.
Since you are not insured your options are to pay for a policy which pays for breast reduction operations and wait for at least a year for the pre-existing provision to stop applying to you OR go to a major teaching hospital where the Plastic Surgery training program has a residents teaching clinic. You MAY be able to get a heavily discounted Breast Reduction operation there in which Plastic surgeons in training would do the surgery while supervised by as teaching Plastic surgeon.
Breast reduction and insurance policies
Based on your description- you fit the criteria for a patient that should have a breast reduction and have their insurance company pay for it.
Do a few things first-
1. document your attempts to lose weight for 6 months
2. document your use of NSAIDS and other pain medication for 6 months
3. get a referral for physical therapy to treat your neck and back pain, and request a copy of these visit notes for a 6 month duration of treatment.
4. when you have collected these materials, seek out a board certified plastic surgeon that accepts your insurance and have him/her write a pre-authorization request letter for your surgery.
If your claim is denied, consider paying for the operation out-of-pocket. Its a $8-10k procedure could significantly change your life!
Insurance coverage for breast reduction
Breast reduction is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine. Recently, managed care has adopted stricter standards for coverage, so these problems have to be thoroughly documented in writing by your primary care physician and plastic surgeon. They may also have to submit photographs. Even then, you may be required to seek a second opinion from a chiropractor, physical therapist, or orthopedic surgeon.