Step by step procedure for getting insurance to cover beast reduction surgery?

I would first call your insurance company and see what they will cover.  Secondly, I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery, a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

One path does not work for all patients, and many times it is dependent upon your perseverance.  Read your certificate of coverage. Find a board certified plastic surgeon (BCPS) who is in-network with your insurance and schedule a consultation with the BCPS (you may need a referral from your general practitioner).  Make sure the BCPS's letter of preauthorization or precertification includes the documentation of your medical necessity. If it is denied, the insurance company will tell you what additional information is required.

Thank you for your question. Dealing with insurance can be complicated and tricky. If anyone out there had a step by step guide on how to go through the process and assure an outcome, everyone would use that strategy. Unofrtantely, there is no such thing. Every insurance is different and even different plans under the same carrier can have different requirements. The best thing you can do it have your primary care doctor document your concerns and complaints and refer you to a local board certified plastic surgeon who performs breast reduction for insurance. The surgeon can examine you and submit to your insurance for approval and go from there. You can also call your insurance directly and ask them to share with you whether the procedure is covered and what the approval criteria are and this may help you to start the process.Best of luck!

Thank you for your question and there is no secret to getting this approved.  Since you have Kaiser, you will need to see their plastic surgeons and have them determine if they will cover your surgery otherwise you will have to pay for this yourself.  I have found Kaiser not unreasonable in approving this surgery for their patients if you fit their criteria.

Hello and thank you for your excellent question. Unfortunately, dealing with insurance companies is often a challenging task. Your best option to see if your procedure is covered, is to contact your insurer to get details about coverage and requirements before approval for surgery (as you are doing). Given the difficulties of dealing with insurance, you can consider paying out of pocket for the surgery. For our patients, the out-of-pocket expenses for an insurance plan often approximate (or even exceed) the cost for the procedure. You can then obtain documentation from your surgeon to attempt to get reimbursement from your insurer. Any treatment plan should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   Preoperative visualization and surgical simulation with the Crisalix system may help with your decision. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon.  Good luck! 
Best,

Jon Ver Halen, MD FACS 

Harvard educated plastic surgeon

You need to visit with one of the Plastic Surgeons at Kaiser in order to determine if you met their Kaiser's requirements for a covered breast reduction. Once the surgeon has determined that you in deed meet those requirements you can get scheduled.