Will Molina Healthcare of Ohio Pay for Breast Reduction?

Question

I am a 38 DDD, my breasts are heavy and do sag. I get a lot of neck, shoulder, and back pain b/c of them. I do have indentations on my shoulders from my bra straps and under my breasts are always red.

	How do I go about getting this started and most importantly, will Molina Healthcare cover it? Any feedback is most appreciated, thank you.

Otto Joseph Placik, MD · Answer

You should be examined by a participating plastic surgeon, who can then compose a letter of predetermination of benefits to be submitted to your health care provider.

Tom J. Pousti, MD · Answer

Unfortunately,  the only way to know about your specific policy is to call the insurance company directly.

	The best way to obtain insurance coverage for breast reduction surgery involves some &ldquo;hoops&rdquo; to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance &ldquo;authorization&rdquo; for the procedure.
	This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you're saying a well-trained/experienced board-certified plastic surgeon. 

	Best wishes

Steven Wallach, MD · Answer

Every insurance company is a bit different with regards to coverage for a breast reduction. You should contact your insurance company to find out their criteria.

David A. Robinson, MD · Answer

Insurance coverage for breast reduction surgery has become more difficult over the years with insurance companies tightening their requirements for approval.
To optomize your chances of being approved you should first go to your insurance companies website. There you will find the requirements necessary for you to meet to be approved. A letter from your primary care physician, in addition to one from a plastic surgeon (along with pictures), are usually required. There is also a minimum amount of breast tissue you will need to have removed for your surgery to be approved.  Your plastic surgeon will submit supporting documentation on your behalf in hopes of obtaining approval for you.
Good luck

George J. Beraka, MD (retired) · Answer

Answer by George J. Beraka, MDManhattan Plastic Surgeon80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.
1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.
2) Very big reductions (like from an F cup to a C cup) will usually be covered.
3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.
4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.
5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.
6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.
7) Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.
8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.
9) Don't give up. If the first request is denied, demand an appeal.
10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

Will Molina Healthcare of Ohio Pay for Breast Reduction?

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