My PS got my breast reduction surgery approved based on an amount of 360 grams of tissue being removed from each breast. After the surgery, he only took 200 grams out of each breast fro a total of 400 grams. My insurance is not denying my claim. I did not do a pre-approval, but they did give a pre determination of approval. How could he have been so "off" on the amount taken out?
February 20, 2013
Answer: Problems with breast reduction insurance coverage
This is one reason why I refuse to do breast reduction surgery. I work for the patient to give them the absolutely best result. I will not be dictated to by an insurance company about how much breast tissue is appropriate to remove. It is only an estimate. The problem is that as the plastic surgeon you are responsible for the surgical outcome. If too much breast tissue is remove in some cases there can be wound healing problems, excessive scarring and loss of the nipple and areola. The insurance company is not going to take responsibility for any of the problems as you mindlessly remove a predetermined and completely arbitrary volume of breast tissue. The denial of your claim should be vigorously fought. The insurance company has placed your plastic surgeon in a position where is his no longer your advocate. Welcome to the future of medicine.
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February 20, 2013
Answer: Problems with breast reduction insurance coverage
This is one reason why I refuse to do breast reduction surgery. I work for the patient to give them the absolutely best result. I will not be dictated to by an insurance company about how much breast tissue is appropriate to remove. It is only an estimate. The problem is that as the plastic surgeon you are responsible for the surgical outcome. If too much breast tissue is remove in some cases there can be wound healing problems, excessive scarring and loss of the nipple and areola. The insurance company is not going to take responsibility for any of the problems as you mindlessly remove a predetermined and completely arbitrary volume of breast tissue. The denial of your claim should be vigorously fought. The insurance company has placed your plastic surgeon in a position where is his no longer your advocate. Welcome to the future of medicine.
Helpful
February 19, 2013
Answer: Post-op Insurance denial of Breast reduction
Sorry to hear of your predicament. Insurance companies are usually very strict in specifying the resection weight (gm of tissue)/side as well as ensuring that your BMI (Body Mass Index) is "normal". Insurance doesn't want to sponsor "cosmetic surgery" and a mastopexy is a small breast reduction (i.e. 200gm vs 360gm). Did you and your PS agree on a) your desired cup size & b) whether (s)/he felt the predetermined weight was appropriate? Assuming you both agreed that breast reduction was indicated to relieve your symptoms and that your targeted "cup" size could be maintained, you should discuss your concerns with him/her and ask for a letter to appeal the insurance company's denial. Good luck.
Helpful
February 19, 2013
Answer: Post-op Insurance denial of Breast reduction
Sorry to hear of your predicament. Insurance companies are usually very strict in specifying the resection weight (gm of tissue)/side as well as ensuring that your BMI (Body Mass Index) is "normal". Insurance doesn't want to sponsor "cosmetic surgery" and a mastopexy is a small breast reduction (i.e. 200gm vs 360gm). Did you and your PS agree on a) your desired cup size & b) whether (s)/he felt the predetermined weight was appropriate? Assuming you both agreed that breast reduction was indicated to relieve your symptoms and that your targeted "cup" size could be maintained, you should discuss your concerns with him/her and ask for a letter to appeal the insurance company's denial. Good luck.
Helpful