Like many women, I have struggled with back, neck, and shoulder problems since high school due in large part to having DDDD breasts. Since I want the surgery for medical reasons and have already done years of chiropractic and a year of physical therapy, I'm hoping insurance will cover it. I'm wondering though if I need a referral, or if I can just have a consultation and provide my therapy records. Thank you!
Answer: Insurance for Breast Reductions Great question! Whether or not you need a referral is actually based on your insurance plan and you can check with them to find this out. If you have one, you would provide it to our office, but there is more that is required. If you have previous progress notes, they are helpful, but it is important to make sure the documentation notes that you believe the pain/problem is associated to the size of your breasts. In addition to this, you will need documentation of conservative treatment and a recent mammogram within the last year if you are over the age of 40. Call our office at any time so that one of our coordinators can talk you through these steps and they even have a document to send via email that outlines the requirements as well.
Helpful 1 person found this helpful
Answer: Insurance for Breast Reductions Great question! Whether or not you need a referral is actually based on your insurance plan and you can check with them to find this out. If you have one, you would provide it to our office, but there is more that is required. If you have previous progress notes, they are helpful, but it is important to make sure the documentation notes that you believe the pain/problem is associated to the size of your breasts. In addition to this, you will need documentation of conservative treatment and a recent mammogram within the last year if you are over the age of 40. Call our office at any time so that one of our coordinators can talk you through these steps and they even have a document to send via email that outlines the requirements as well.
Helpful 1 person found this helpful
Answer: Insurance coverage for breast reduction With today's insurance plans under the ACA, less and less insurance companies cover breast reduction surgery despite if you may have symptoms such as painful bra strap grooving, neck, shoulder and back pain overly large breasts. However, I suggest contacting your insurance company and asking exactly what is and isn't covered in regards to treating macromastia with a breast reduction. If they do offer coverage then ask for a list of in network providers whom you can then contact to set up an appointment and consultation with to address your concerns.
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Answer: Insurance coverage for breast reduction With today's insurance plans under the ACA, less and less insurance companies cover breast reduction surgery despite if you may have symptoms such as painful bra strap grooving, neck, shoulder and back pain overly large breasts. However, I suggest contacting your insurance company and asking exactly what is and isn't covered in regards to treating macromastia with a breast reduction. If they do offer coverage then ask for a list of in network providers whom you can then contact to set up an appointment and consultation with to address your concerns.
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September 25, 2017
Answer: Do I need to be referred to a PS by my PCP in order to have my insurance cover a breast reduction surgery? Read your medical insurance certificate of coverage which will state whether a referral from your PCP is required for a consultation with a board certified plastic surgeon which may have to be in their network of preferred providers. BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered by medical insurance. If not, your insurance company may try to deny you based upon a lot of things such as weight, lack of enough tissue that should be removed, lack of symptoms, and lack of previous medical management.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA
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September 25, 2017
Answer: Do I need to be referred to a PS by my PCP in order to have my insurance cover a breast reduction surgery? Read your medical insurance certificate of coverage which will state whether a referral from your PCP is required for a consultation with a board certified plastic surgeon which may have to be in their network of preferred providers. BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered by medical insurance. If not, your insurance company may try to deny you based upon a lot of things such as weight, lack of enough tissue that should be removed, lack of symptoms, and lack of previous medical management.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA
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September 26, 2017
Answer: Breast reduction referral My advice would be to call the plastic surgery office that you are choosing to go to and ask them. Their staff should be quite knowledgeable about what requirements are needed to have the consultation and even the surgery. It's also a good test of the office to see how efficient they are.
Helpful
September 26, 2017
Answer: Breast reduction referral My advice would be to call the plastic surgery office that you are choosing to go to and ask them. Their staff should be quite knowledgeable about what requirements are needed to have the consultation and even the surgery. It's also a good test of the office to see how efficient they are.
Helpful
September 25, 2017
Answer: PCP referral required? Best to check the terms of your particular health insurance policy to determine whether you require a primary referral to see a specialist (Plastic Surgeon). Some policies require a referral and some do not.
Helpful
September 25, 2017
Answer: PCP referral required? Best to check the terms of your particular health insurance policy to determine whether you require a primary referral to see a specialist (Plastic Surgeon). Some policies require a referral and some do not.
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