I went in for breast reduction consultation and the doctor didn't take my height or weight, will insurance need this?

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions. This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive
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You surgeon will be sure to submit what is needed.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

There are a set of criteria that have to be met in order for insurance to consider breast reduction surgery as medical necessity.  One of the things they need is the BSA, body surface area.  This is calculated from the height and the weight of the patient.  Then the BSA is compare to a sliding scale and a determination is made on how much breast tissue is required to be removed in order for insurance to want to cover the expense.Hope that helps.

Yes indeed. The insurance company will always ask for height and weight and in essence your BMI. You can easily send this information to your surgeon. 

Thank you for reaching out. I would agree with a few of the previous answers that height and weight are factors that should be given to the surgeon at a consultation. Those questions are typically on the patient info forms you fill out.  A lot of surgical decisions and medication amounts are determined on those factors. Maybe go on a few more consultations with experienced board certified surgeons. best of luck! Dr. Kachenmeister

All US insurance companies use the patient's height and weight to determine how much breast tissue your surgeon must remove in order to have the surgery paid for by your insurance. That said there is no correlation between the relief of symptoms and the amount of tissue to be removed to merit insurance coverage.  Patient's who do not meet insurance criteria may still benefit from breast reduction surgery.

You are correct that height and weight are important for preoperative consultation and acquiring insurance approval for breast reduction. This is mostly because the body surface area, which requires knowing the height and weight, is used to help calculate the amount of breast tissue the surgeon needs to remove to meet the insurance company's criteria for payment of the services rendered. The surgeon has to estimate preoperatively the right amount to remove and calculate it against a sliding scale used by most insurers. An often used shortcut is to ask the patient her height and weight without formally measuring it, which I do not think is ideal as patients can report incorrect information; the proper approach is to formally measure in the doctor's office and record it in the medical record.

Breast reduction requires use of a Schnur scale to get authorization; the Schnur scale does require obtaining height and weight in order to determine your body surface area which will determined how much weight must be removed from each breast for medical coverage to be obtained. 

Hello and thank you for your excellent question. Congratulations on your decision to have a breast reduction. Our patients are very satisfied with this procedure. In general, yes, it is necessary to take your height and weight before a procedure, particularly if you are planning on applying to your insurance for coverage. Of course, you will need an in-person consultation to evaluate you for this procedure. Preoperative visualization and surgical simulation with the Crisalix system may help with your decision. I suggest that you find a board-certified plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of patients who have had similar procedures. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc”

Yes, you are correct. If the office misses little things like this I would be very worried about more serious oversights. If I were you I would find a different office for your surgery.