Experience when patient hasn’t met Schnur scale requirements?

Question

Hello, I am reaching out to any doctors who may have done an insurance pre-authorized breast reduction on a patient who didn’t end up taking out the required Schnur scale grams? How did insurance react? Experiences with the patient? I am a bit worried as I’m pre-approved for 350 grams, but doc said he may only end up removing ~200. He said he’s never had my insurance problems, but is that the experience of other surgeons?

Irena Karanetz, MD · Answer

Hi,
Thank you for the question. 
As long as everything is documented properly the operative report, the pre-approved weight is usually not an issue even if it's under the estimated amount in grams.
I hope this helps.
Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Gary M. Horndeski, MD · Answer

I have never had an insurance company authorize a breast reduction with only 200 grams removed. I do not believe you will be covered. It is better getting this resolved before surgery otherwise you will get a pricey hospital after surgery.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

With most insurance companies, if the approved amount of breast tissue is not removed, the procedure is not covered. Insurance companies will not budge on this amount. Noncoverage will also include the fees of anesthesia and the surgical facility in where the surgery was performed. With noting covered, you will be required to pay everything. Your surgeon does want to keep enough tissue to keep your nipples alive. Below that amount, you may need free nipple grafts which will leave you with no sensation nor function.  Please go back and discuss all of this with your surgeon.  You might want to pay yourself and let your surgeon give you the appropriate size breasts with functioning nipples.

Scott C. Lindsay, DO · Answer

Thanks for your question! This can happen with breast reduction and certain insurances. It is becoming increasingly difficult to get breast reductions covered by insurance. I have a cosmetic breast reduction fee for patients that are not able to proceed through insurance. I would suggest asking your doctor if he offers the same option. Good luck!

Camille Cash, MD · Answer

I encourage you to work out this issue prior to surgery.  You definitely do not want to end up getting a denial and an unexpected bill if you were under the impression that the procedure would be covered.

Experience when patient hasn’t met Schnur scale requirements?

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