I need my insurance to cover my breast reduction w/o having physical therapy. I lost weight before but my breast did not go down

Question

Im 20 yrs old, 5'4 and 169 lbs. My bra size is a 34G/H & I want to be a C cup. I know I am a little overweight and I have lost 6 lbs so far. My breasts give me a lot of neck, back, & shoulder pain. I currently have BCBS EPO of Maryland for insurance and I want to get the reduction by the end of December of this year (it's July) because I am in school. I don't have time for physical therapy because of school, work, etc. Is there anyway I can skip the physical therapy so I can get the reduction.

Tom J. Pousti, MD · Answer

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. Based on your description, it sounds like you may be an excellent candidate for the procedure.

Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, the more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.

This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform.

Also, prepare to be persistent when dealing with health insurance companies. Best wishes.

Praful Ramineni, MD · Answer

I perform approximately 2 breast reductions a week through insurance and have not had any insurance companies require physical therapy.  In general the criteria are that you have symptoms (which you do), have failed conservative therapy (can be wearing bras/support garments) - sounds like you have and that we remove the appropriate number of grams for your Body Surface area (calculated by your height and weight) - this is then used to look up a number on a Schnur scale (each insurance company has different criteria) and if your surgeon feels as though this is a reasonable amount of tissue to remove to achieve your goals, then surgery can be planned.  Check your benefits for your EPO to make sure you stay in network - if you have Care First, blue cross - most of the practices in the DC/MD/VA area who are participating should be in network.

I need my insurance to cover my breast reduction w/o having physical therapy. I lost weight before but my breast did not go down

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I need my insurance to cover my breast reduction w/o having physical therapy. I lost weight before but my breast did not go down

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Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.