My Dr. Ordered 800 CC/breast. My Insurance Said It Needs to Be 1800. Is That Risky?

I think there is some miscommunication. In order to cover breast reduction surgery all insurance companies require medical record documentation of symptoms caused by large breasts like shoulder pain, skin rashes etc and a variable period of a trial of conservative therapy like support bras. Most also require that a specific amount of tissue related to body surface area be removed in order to meet medically necessary non-cosmetic criteria. In your case that would be between 800 and 820cc given your BSA of 2.14. If they are requiring the removal of such a large amount of tissue and you have a letter from them stating so you need to report that company to your state insurance regulatory agency and demand that the case be reviewed by an external reviewer.

Aside from that your BMI is 39.9 and your height weight ratio makes you morbidly obese. You should seriously consider weight loss or weight loss surgery before any body contouring surgery for health and safety reasons and to ensure a safe breast reduction surgery with less chance of complications and a more optimal result.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Hello, and thank you for your question.  I'm not sure that I understand your question.  I give it a try.

It sounds as though you're considering a breast reduction.  If I'm mistaken you can pretty much ignore the rest of this answer.

If a breast reduction is to be covered under insurance which is becoming increasingly more difficult we generally submit photographs of the patient, the indications for the surgery, and an estimate of how much tissue will be removed to the insurance carrier.  With this information the insurance carrier may approve or disapprove under the your policy coverage for breast reduction surgery.

It sounds and your question is though your doctor Estimated about 800 g per breast, but your insurance carrier may not be willing to cover your surgery unless he takes off 1800 g? 1800 g is a huge amount of breast tissue so again I apologize if I'm not understanding the question. For example Blue Cross generally requires about 600 g per side.

You may want to post this one again with a little bit more detail.

 

Best wishes.