Insurance Denied Coverage of Breast Reduction - How Can I Appeal?

Question

My insurance has denied authorization for breast reduction surgery. What would be the best info to appeal their decision? I have a worn T5 in my curved spine and suffer from low back referred pain as well. I am very tired of living with these conditions. I also have fibromyalgia that my insurance reviewers considered to be the primary cause of my pain. I need some relief!

Otto Joseph Placik, MD · Answer

There are no secret weapons but persistence is a virtue when it comes to insurance companies. Consider taking a 10 pound weighted bra into the CEO of the insurance company and asking him/her to wear it 24x7 for just one week.

Scott C. Lindsay, DO · Answer

Hello and thank you for your question!
I would definitely appeal. Reach out to your insurance company for information on the appeals process and what specifically needs  to be submitted.  Your Plastic surgeons office should be able to help you as well. Good luck!

Christopher V. Pelletiere, MD · Answer

What you need to do is talk to your insurance company and see what it takes to get authorized from their perspective. With that infomation, you can then talk with your surgeon and see what may need to be done. Some want you to go to physical therapy first, while others want notes from an orthopaedic surgeon, etc. It can be a struggle, but just keep fighting with them and see what it is going to take.

Tom J. Pousti, MD · Answer

Thank you for the question.

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. Be persistent.

Best wishes.

Steven Wallach, MD · Answer

Every insurance company is a bit different with regards to coverage for a breast reduction. You should contact your insurance company to find out their criteria. You would have to appeal the denial as well.

Insurance Denied Coverage of Breast Reduction - How Can I Appeal?

Answers (7)