Steps to Breast Reduction?

Hi kendrakay97,
Yours is a great question. In general, women presenting for breast reduction consultation via insurance will have:1. Symptoms, including back and neck and shoulder pain, bra strap grooving, trouble finding clothes that fit, awkwardness in social situations, and others2. A documented history of multiple visits to primary care physician regarding large breasts.3. Potentially a documented history of multiple uses of physical therapy, massage therapy, and/or chiropractic therapy.
In order to have a useful visit with the surgeon, the above criteria should generally be met. During your visit with the surgeon, he or she will estimate the approximate removal weight, and will package a complete history and physical exam, along with anticipated removal weight, and documentation of numbers 1 through 3 above, when the insurance preauthorization letter sent. All of these together are no guarantee that the insurance will provide coverage for the surgery, but it certainly helps to of all your documentation intact for that original submission.
Hope this helps.
Best,Christopher Pannucci MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Thank you for your question. I would suggest doing some research on Board Certified Plastic Surgeon's who do Breast Reductions in your area. Schedule a consultation with them and ask if they accept insurance and or to reach to your insurance for you. You do not have to start a prior authorization on your own. You could also reach out to your insurance company to see if there are any Board Certified Plastic Surgeons in network as well. Best of luck to you on this journey.

Thank you for your question.
Your plastic surgery office will be the one to contact your insurance. The first step would be to gather letters of medical necessity. These letters are written by doctors discussing your symptoms and the necessity for this procedure. They are often written by OBGYNs, chiropractors, primary care providers, dermatologists, and even psychiatrists. From there, you can bring these letters to meet with your plastic surgeon for evaluation. They will likely take photos to submit alongside your letters to the insurance company. In around six weeks, you should have an answer about your coverage and be able to schedule surgery.

I would suggest that you find a board certified plastic surgeon and make a consultation with them. During that consultation they will gather all the pertinent information that your insurance company will need. After the consultation the office will submit the information to your insurance company for approval. I hope this helps.

Hello and thank you for your question!
Schedule a consultation with a board certified plastic surgeon to discuss your options. Your surgeon will send in the necessary paperwork to your insurance company. It may take 6 to 8 weeks to hear back with an approval or denial. Best of luck!

Dear kendrakay97,
finding the right Dr. is extremely challenging especially with the number of online platforms and resources available. There a lot of great Dr's available. Make sure he/she is a board-certified plastic surgeon. Definitely check to make sure your choice specializes in the procedure you want and spend the time to read through patient testimonials. There is a number of different sites where you can check for reviews (Realself, yelp, google, etc.).You can always pick up the phone and call around also, find an office you feel comfortable with and set up a few consultations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

You will want to first contact your insurance carrier to determine if breast reduction is a covered benefit under your policy. If it is you carrier may only work with certain surgeons, so you will need to access a list of those physicians. Most insurance carriers will require that certain criteria is met in order for the procedure to be approved. This may include things such as a minimum amount of tissue to be removed and proof of prior non surgical interventions. The criteria will vary by policy.

Great question. Large breasts (macromastia) can cause neck and shoulder pain, shoulder grooving and rashes under your breasts. Insurance will often cover breast reduction surgery. This procedure can often be performed as an outpatient under IV sedation without general anesthesia. There are different surgical approaches, including some with smaller scars. Speak with a plastic surgeon to discuss your options. Your plastic surgeon can then work with you and your insurance company to see about coverage options.

Hello!
The first thing I would recommend doing is contacting your insurance to see whether breast reductions are covered by your plan. In today's healthcare environment, more and more insurances are carving out breast reductions as covered procedures. You can also ask them at that time whether you first need to see your PCP or can visit a specialist directly. Many HMO plans will require the former while PPO plans are ok with you visiting a surgeon directly. From there you can set up your consultation. The Plastic Surgeon you do visit will handle the insurance prior authorization process on your behalf including submission of medical records and the request to proceed. You and the doctor are then informed of the insurances approval or denial and you are free to schedule surgery, either covered by insurance or as a cash pay option if not.
Good luck!
Dr. Tom Korkos

If you’re considering breast reduction, it’s crucial to consult with a skilled healthcare professional. They can assess your individual needs and discuss potential steps, which may include:1. Consultation: Schedule a consultation with a plastic surgeon or a specialized healthcare professional.2. Evaluation: The surgeon will assess your health, discuss your goals, and determine if you’re a suitable candidate.3. Planning: If surgery is recommended, the surgeon will discuss the procedure, potential risks, and expected outcomes.4. Pre-operative preparations: Follow any pre-surgery instructions provided by your healthcare team.5. Surgery: Breast reduction surgery typically involves removing excess breast tissue, reshaping the breasts, and repositioning the nipples.6. Recovery: Follow post-operative care instructions, including rest, pain management, and avoiding strenuous activities.7. Follow-up: Attend follow-up appointments to monitor your recovery and address any concerns.Always consult with a healthcare professional for guidance based on your specific situation.