How often do you see a patient get their insurance's approval for Breast Reduction with just your letter and photos sent in?

I know all insurance companies are different in what their policies are, but that's not what I'm asking about entirely. Many insurances want you to have done physical therapy for months, talked to your primary care doctor numerous times about the problems having large breasts bring, a letter from a chiropractor, etc. So, is it often/how often are you able to get a patient approved for surgery with their insurance covering it, with just your own letter and photos from the consultation?

Doctor Answers 4

Insurance and reduction

It is getting harder and harder to approve.  If your insurance company wants documented proof that conservative management will not help, then that is what you have to do.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

How to have a #breastreduction covered under health insurance

Thank you for your question about having the breast reduction procedure covered under insurance. I agree with my colleagues in this forum that it is becoming increasingly more difficult for the breast reduction procedure to be covered under insurance. It is also extremely important to be upfront and honest with your operative surgeon about any past surgeries and your full health history as all of these factors play a role in insurance coverage. I hope this is helpful and encourage you to meet with a plastic surgeon certified by the American Board of Plastic Surgery and a member of the ASPS.  I hope this is helpful.  -Brian S. Coan, MD, FACS

Brian Coan, MD, FACS
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 63 reviews

Breast reduction and insurance.

It has become far more difficult to get insurance to cover Breast reduction. The companies often make patients jump through hoops. They often ask for weight loss when it is almost impossible  to exercise with massive breasts. If you wish to go this route first be sure it is even covered under your plan. Many companies don't cover it at all.  Be realistic as only the largest are covered. Begin a paper trail that confirms and supports the need for reduction. Be prepared to fight for it. Companies will often listen to the patients more than the doctors.

Many companies now state no approval necessary-- but will not reimburse post surgery, so be careful. Be sure your approval is guaranteed in writing.

I hope this helps.

Adam Tattelbaum, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 105 reviews

Approval for breast reduction

Thanks for your question. As you said, it varies widely on what insurance companies require to approve reduction surgery. However, if the patient is really large-breasted and suffering from symptoms because of it, I've not had a lot of trouble getting them approved. It's a great operation that really helps women dealing with this problem. There are occasional wound healing issues, but once everything is healed, just about every patient says they would do it again if they had to. Best wishes.

Paul J. Leahy, MD
Leawood Plastic Surgeon
5.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.