Steps to Breast Reduction?

Question

Hi, I'm starting the process of searching for doctors for my breast reduction surgery. I've been gathering referrals and proof for insurance to years now. My question is, do I reach out to insurance for approval before meeting with a surgeon? Or do I have a consultation and discuss insurance then? I guess I'm wondering how this process usually goes and what order I should follow to make it as simple as possible. Thank you!

Christopher Pannucci, MD, MS · Answer

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

Camille Cash, MD · Answer

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.

Stephen T. Greenberg, MD, FACS · Answer

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.

Tommaso Addona, MD · Answer

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.

David Branch, MD · Answer

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.

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