CCG refused my request for Breast reduction on my 30JJ breasts, Is it worth appealing?

I am 26 years old and my request to reduce my 30JJ breasts has been rejected. I have been going to my doctor with backache since the age of 13, done Physio and I am currently taking pain relief on a daily basis. I have lost 4 stone in an attempt to reduce them, I have shoulder grooving, intertrigo and daily headaches. I have scoliosis and spina bifida occulta. A specialist said I had acquired thoracic kyphosis. Is it worth appealing decision, please can someone offer some advice and experience.

Doctor Answers 2

BR and Insurance

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Under certain circumstances Breast Reduction is covered by insurance. 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. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses

Breast reduction - turned down by CCG

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Thank you for asking about your breast reduction.
  • It certainly is worth appealing.
  • I suggest you contact CCG to find out why they turned you down and what you need to do to meet criteria.
  • At least in the USA, and probably in the UK, it helps to hire a lawyer to file the appeal -
  • Ask the specialist what in her/his experience has been most effective.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.