Hello! I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. (25 y/o female with a 38J bra size) according to aetna, I should more than qualify for a reduction as I have back, neck, shoulder pain, chest pain and pressure, arm numbness while laying on sides, etc. But they denied my dr's request for "cosmetic" reasons, but its all health related for me. I have a referral to a phys. Therapist. Help, what else can i do?
April 28, 2015
Answer: Insurance coverage for breast reduction The saying "the squeaky wheel gets the grease" can apply in this situation as well. If you're persistent in your letters and calls to the insurer, they may reverse their decision and approve your surgery. Check Aetna's guidelines for breast reduction coverage on their website, then send a letter with all of the necessary information including your height/weight and symptoms. See if your plastic surgeon can give you an estimate of the weight of breast tissue he might remove from each side and include it with your letter. Your surgeon may not have submitted a good letter on your behalf. Follow up the letter with phone calls. You're the consumer, not the surgeon, so they care more about angering you than angering the surgeon. If your breasts truly look very large, you might also want to include photos from different angles (like those on this website). If nothing works, you can obtain price quotes from one or more surgeons and pay for the procedure. Financing options exist if needed.Good luck!Andres Taleisnik, M.D.
Helpful 1 person found this helpful
April 28, 2015
Answer: Insurance coverage for breast reduction The saying "the squeaky wheel gets the grease" can apply in this situation as well. If you're persistent in your letters and calls to the insurer, they may reverse their decision and approve your surgery. Check Aetna's guidelines for breast reduction coverage on their website, then send a letter with all of the necessary information including your height/weight and symptoms. See if your plastic surgeon can give you an estimate of the weight of breast tissue he might remove from each side and include it with your letter. Your surgeon may not have submitted a good letter on your behalf. Follow up the letter with phone calls. You're the consumer, not the surgeon, so they care more about angering you than angering the surgeon. If your breasts truly look very large, you might also want to include photos from different angles (like those on this website). If nothing works, you can obtain price quotes from one or more surgeons and pay for the procedure. Financing options exist if needed.Good luck!Andres Taleisnik, M.D.
Helpful 1 person found this helpful
April 28, 2015
Answer: Insurance denied coverage for a breast reduction It isn't clear from your question- have you seen a plastic surgeon regarding breast reduction? Your primary care physician would not be submitting paperwork to insurance for preapproval for surgery. If you have been denied coverage for breast reduction, there are two possible reasons:Your insurance company does not consider surgery medically necessary. If this is the case, your surgeon can file an appeal. If the appeal fails, your only option is to pay out of pocket for surgery.Your insurance company has breast reduction listed as an excluded procedure. This means it is not covered reglardless of whether it is medically necessary. Best of luck to you.
Helpful
April 28, 2015
Answer: Insurance denied coverage for a breast reduction It isn't clear from your question- have you seen a plastic surgeon regarding breast reduction? Your primary care physician would not be submitting paperwork to insurance for preapproval for surgery. If you have been denied coverage for breast reduction, there are two possible reasons:Your insurance company does not consider surgery medically necessary. If this is the case, your surgeon can file an appeal. If the appeal fails, your only option is to pay out of pocket for surgery.Your insurance company has breast reduction listed as an excluded procedure. This means it is not covered reglardless of whether it is medically necessary. Best of luck to you.
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