Will I get covered by Molina insurance for a breast reduction since I have scoliosis? (photos)

Question

I am a 20 year old 5'0 115lbs mother of 3. I have scoliosis. I just had my last child and I'm currently breastfeeding but will be stopping soon. I don't know my proper bra size. I'm looking to get done to a smaller cup size that actually fits my body properly. Also big boobs run in my family and I started developing them at the age of 9 so it was already huge before I had my children. How long after breastfeeding can I get a breast reduction? Will I be able to go back to school in a week?

Jose Perez-Gurri, MD, FACS · Answer

Hi. Your insrance company may or may not cover. You have to read the explanation of benefits. Some insurance companies have a threshold in the amount of weight removed in order for them to consider payment. Others, simply exclude breast reduction altogether. I would wait at least 4-6 months after breast feeding. You'll be abkle to go back to work after 1 week as long as your work does not require heavy lifting. Good luck.Dr. PG

Gary M. Horndeski, MD · Answer

Thank you for you question and photos,            
The Bellesoma Method is a current technique to lift and/or reduce breasts without using implants or the ugly vertical scars.  The incisions are hidden around the areola and in the inframammary crease. The vertical incision has been completely eliminated. The areola incision heals almost invisibly due to the fact that there is hardly any tension on the closure. With this particular technique, ducts are preserved along with nerve supply maintaining nipple sensation and the ability to breast feed. Because the breast is reshaped internally and is secured to your chest muscles, upper pole fullness is possible without an implant. Attached is a patient who underwent The Bellesoma Method. Please note that her tissue was used to create upper pole fullness and cleavage without any foreign materials (mesh, implants, etc).  Unfortunately, we do not accept insurance for breast reductions.  Dr. Horndeski does not remove enough breast tissue to meet insurance criteria.  Instead, he utilizes the breast tissue to reshape the breast.  It is a proprietary technique that only surgeons that have been trained by me can perform. I hope this helps. 
Best wishes and kind regards, 
Dr. Gary Horndeski

Kenneth Hughes, MD · Answer

None of us can predict the decisions insurance companies will make regarding coverage for BR surgery or what documentation will sway their decision. BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered by medical insurance. If not, your insurance company may try to deny you based upon a lot of things such as weight, lack of symptoms, lack of previous medical management, and lack of enough tissue that should be removed. 
Read the Molina certificate of coverage. Determine what medical information is required for Molina to issue a pre-authorization or predetermination of benefits for BR surgery. The lactation process should be complete prior to breast surgery.  Continue to provide your baby with the benefits of your breast milk and when you have ceased lactating for six months or so, consult with a board certified PS who can evaluate your medical condition, discuss the pros and cons of this surgery as it applies to you, determine the amount of tissue to be removed, and help you in completing the paperwork required by the insurance provider.  Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Darryl J. Blinski, MD · Answer

That is a very inexpensive heath plan with major restrictions to any type of plastic surgery. Plus the reimbursement to the surgeon is so very little might be hard to find a boarded expert PS to accept this low fees structure. Sorry and Good Luck.

Will I get covered by Molina insurance for a breast reduction since I have scoliosis? (photos)

Answers (4)

More Breast Reduction Questions

WE SEND PRETTY
EMAILS

Answers (4)

More Breast Reduction Questions

Breast reduction wound getting bigger. Treating it with Silverdene for 2 weeks. (photo)

I’m over 2 Wks post op from breast reduction and my breasts hurt so much when it’s cold. Why? What can I do?

Pulling feeling - 4 months post-op breast reduction.

Should I be using an ice pack or heating pad 2 days post reduction?

Nipple necrosis?! Day 10 after breast reduction. (Photo)

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS