Orthopedic Test Needed, Any? for Breast Reduction.

I have to see a orthopedic because its required by insuror.I need to see a physical therapist for 6 months too! Are there any test the orthopedic should have done? He just gave me a script to see the PT.

Doctor Answers 3

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

Insurance companies can insist on meaningless therapy prior to approving breast reduction.

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No orthopedic consultation or any amount of physical therapy is going to make your breasts smaller. If the large size is the cause of your discomfort only a breast reduction will improve the problem. Unfortunately insurance companies sometimes insist on these ridiculous diversions away from the operation.

Breast Reduction Testing

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Back and neck pain from enlarged breasts is common and not a diagnostic mystery. Further testing is not helpful and in fact wasteful.  Your Orthopedic surgeon made the correct diagnosis and referral.  The problem lies with the arbitrary requirements placed on patients by insurance companies that do not have much medical rationale.  Your insurance company is hoping that you will get frustrated and forget about having a breast reduction.  Continue what you are doing and document your efforts. Best wishes.

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