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

Question

I went in for breast reduction consultation that I am hoping to have approved by my insurance. I had 3D pics taken but the doctor didn't take my height or weight, isn't this something the insurance company will want proof of? Is there a reason this wasn't done?

Urmen Desai, MD, MPH, FACS · Answer

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

Larry S. Nichter, MD, MS, FACS · Answer

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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Farbod Esmailian, MD · Answer

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.

Payman Danielpour, MD, FACS · Answer

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.

Robert M. Kachenmeister, MD · Answer

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

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

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

Answers (10)

Answer: Breast reduction

Answer: Breast reduction

Answer: Important

Answer: Important

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Everything you need to know about Breast Reduction

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