What More Do Insurance Companies Want? 127lbs, 5'4, Hcup; Extreme Pain and Numbness In Hands and Neck?

I am165 cm tall, weigh 58kg and wear an 8H bra. I have been diagnosed with degenerative spondylitis in the last 12 months, and have 2prolasped disks in my neck. My hands are constantly numb at night, and I take painkillers everyday. My life is becoming a nightmare. I have 2 letters from doctors and one from my physio, saying that they would recommend a reduction. My insurance company will not cover, although I am not giving up. What more can I offer the insurance company?

Doctor Answers 6

Breast Reduction - What More Do Insurance Companies Want?

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Each insurance company has its own requirements but it sounds to me like you would meet the average requirements in this country.

Each case is different, though.  You may need to switch insurance companies (although you'll have to investigate the potential issue of pre-existing conditions) or you may have become even more persistent including mailing certified letters to local attorney generals or insurance commissioners with copies to the insurance companies.  That may help persuade them.

I hope that this helps and good luck,

Dr. E

Coverage for breast reduction surgery

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From your description you would seem to meet the requirements for insurance coverage for a breast reduction in the US.  Sometimes you just have to be persistent.  Go to the human resources director of your company if you have one and ask for assistance.  Follow the appeal process and don't give up. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Insurance Company Requirements for Breast Reduction?

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I'm sorry to hear about the difficulty you are experiencing obtaining coverage for breast reduction surgery. I'm sure you know that this is not unusual.

It may be in your best interest to call the insurance company directly and ask exactly what requirements you are not meeting. You will find that  and every insurance company has their own “requirements” making it such that generalizations cannot be made online.

Continued to be persistent;  breast  reduction surgery is one of the most patient pleasing operations we perform.

Best wishes.

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They just want you to go away

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Insurance companies make money by taking your payments and not paying anything out. They are there to out live you and take the money and run. You can write the attorney general of your state and go to the press, but the insurance companies usually win. They write their own rules.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Insurance coverage

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Every insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX

Breast reduction would not address your symptoms

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Based on your description of your cervical degenerative disease, breast reduction would not necessarily be 1st line treatment for your symptoms. While removing weight can make things better, you have a primary orthopedic pathology which would need to be addressed before proceeding to breast reduction. Presumably, this was the rationale if your predetermination was denied. Unless you have some contraindication to neck surgery that can be demonstrated, that is probably the order to address your problems.

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.