PS won't see me til I get med recs showing years of issues. Do I have to wait 3 years to document or a note from dr?

Ready for BR Primary, OB, and Ortho say insurance will cover Insurance Cigna open access planumbers Gone to dr twice specifically for back 41 yo 38K 5'3" 200 lbs Shoulder intention Limited exercise abilities Back pain Arthritis in lower back (recently diagnosed) Metro Atlanta area (West side)

Doctor Answers 3

Insurance covered breast reductions

Getting breast reductions covered by health insurance companies has become extremely difficult.  This is getting worse and worse.  Furthermore, many plastic surgeons I know who are "in network" with the insurance companies get paid such low rates for breast reduction surgery that they either 1) avoid doing the operation and make the patient do the work for the authorization or 2) do a fast and less meticulous operation - not what the patient deserves!  Sometimes seeing an "out of network" (or OON) plastic surgeon is a benefit in these cases - especially if the patient has "good insurance".  The OON plastic surgeon can negotiate a reasonable price with the insurance company - and be appropriately compensated for the necessary time needed to do a better job.   I feel that by being OON, I can take the time to do my best and focus on artistic results and the fine details necessary for a superb result.  Plus, the OON surgeon and his team are frequently more motivated to get the authorization!

Miami Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast reduction with insurance?

Every insurance plan has specific requirements, not all of which make sense. Your specific plan may require extensive documentation, etc. You can call the number on the back of your insurance card and ask them what the requirements are for your policy and if your policy covers breast reduction. Once you know what information you need you can approach a plastic surgeon and see if they can assist you.
Good luck.

Asaf Yalif, MD
Roswell Plastic Surgeon
5.0 out of 5 stars 6 reviews

What is necessary to get insurance to cover my breast reduction surgery?

Thank you for your question.  Not all insurance providers have the same requirements.  It is best to go to the source for specific details regarding steps to qualify for insurance coverage of breast reduction.  Some carriers are so rigid in the requirements that many patients may not qualify under their guidelines but will qualify on other carrier's plans.  Most carriers require documentation of symptoms and treatments attempted in addition to medical history and examination with estimated amounts of tissue to be removed to determine qualified candidates.  I have had patients change insurance providers to get a more reasonable plan that covers breast reduction.  As always, seek a Board Certified Plastic Surgeon who specializes in breast reduction.  Good luck.

David J. Wages, MD
Peabody Plastic Surgeon
4.8 out of 5 stars 24 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.