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?
Answer: Breast Reduction - Insurance Coverage? I would recommend seeing a Board Certified Plastic Surgeon who is experienced in working with insurance companies for this particular procedure. It sounds like your primary care physician many not be able to submit the authorization without an opinion from a surgeon. Based on your symptoms you definitely qualify for a breast reduction. #BreastReduction #BoardCertifiedPlasticSurgeon #PlasticSurgery
Helpful 1 person found this helpful
Answer: Breast Reduction - Insurance Coverage? I would recommend seeing a Board Certified Plastic Surgeon who is experienced in working with insurance companies for this particular procedure. It sounds like your primary care physician many not be able to submit the authorization without an opinion from a surgeon. Based on your symptoms you definitely qualify for a breast reduction. #BreastReduction #BoardCertifiedPlasticSurgeon #PlasticSurgery
Helpful 1 person found this helpful
September 21, 2015
Answer: What can I do if my insurance denies coverage for breast reduction? I am sorry to hear about the difficult time you have had obtaining authorization. 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. Look for the insurance companies' "criteria" and find as much support to meet these criteria. Be persistent.Best wishes.
Helpful 1 person found this helpful
September 21, 2015
Answer: What can I do if my insurance denies coverage for breast reduction? I am sorry to hear about the difficult time you have had obtaining authorization. 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. Look for the insurance companies' "criteria" and find as much support to meet these criteria. Be persistent.Best wishes.
Helpful 1 person found this helpful
January 21, 2019
Answer: Insurance Denies Breast Reduction It is hard to believe that your insurance denied your coverage due to it being cosmetic reasons with all the symptoms you have! You might want to see a Board Certified Plastic Surgeon that specializes in breast surgery to reapply for coverage, if you are denied again, ask your surgeon to appeal your case. Then a medical doctor will talk to your surgeon about your specific case. I have gotten several patient approved this way. Good luck!
Helpful 1 person found this helpful
January 21, 2019
Answer: Insurance Denies Breast Reduction It is hard to believe that your insurance denied your coverage due to it being cosmetic reasons with all the symptoms you have! You might want to see a Board Certified Plastic Surgeon that specializes in breast surgery to reapply for coverage, if you are denied again, ask your surgeon to appeal your case. Then a medical doctor will talk to your surgeon about your specific case. I have gotten several patient approved this way. Good luck!
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 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.
Helpful
