I have restricted myself to jobs that allows me to sit more than stand. In the past, when I worked jobs that required lots of standing and walking, I experienced extreme pains and aches throughout my back. For the majority of my adulthood I've had state insurance, I've just recently, in the last 8 months, purchased health insurance from my employer. How do I go about getting a claim started for my insurance company to pay for my breast reduction?
Breast Reduction - I am 5'4 and 116 lbs; my bra size is a UK 30g.
Doctor Answers 7
Insurance coverage for a breast reduction
Breast Reduction - I am 5'4 and 116 lbs; my bra size is a UK 30g
Breast reduction and insurance
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Breast reduction, some advices:
After having analyzed all the information provided to us, i can realize that you have very large breasts for your height and weight, and can be responsible for head, back, neck and shoulder pain. In the future may cause permanent osteo-articular damage in the back and shoulders and skin problems (mainly under the breasts). For for this reasons, certainly you need a breast reduction surgery.Kind regards
Breast reduction - how to get it done?
- I am sorry you have had such problems -
- Your first step is to go to the web site for Criteria for breast reduction.
- They may require, for instance, your doctor's recommendation, a trial of weight loss, chiropractic treatment.
- I know this doesn't make sense - but it's how insurance does it.
- Make sure you meet these criteria
- Then call your insurer, speak to a human being to discuss the criteria, the process and anything anything you have missed.
- Then find on the website the plastic surgeon's on your insurance panel.
- See the plastic surgeon for a consultation and take the insurance criteria with you.
- S/he will submit a Letter of Pre-determination to have insurance approve the surgery, based on the criteria.
- Once your insurance approves the surgery, you need to have it done (usually in 6 months) or the approval expires.
Breast Reduction and Insurance Concerns...
Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, the more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. Also, prepare to be persistent when dealing with health insurance companies. I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.
How to get your insurance company to pay for your reduction?
This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive.
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.