Paper trail for breast reduction

Question

I’ve recently went to see a plastic surgeon for my large breast I’m a triple D and I’m 5’3 , my Surgeon said my insurance would pay for it all but after i left and a few weeks went by I’ve got a letter saying i need a paper trail before i can get approved , what does that mean ? The letter said i needed to talk to my primary care doctor to get the steps started but how long does that take and will i get approved after ?

Nathan W. Patterson, MD, FACS · Answer

I would recommend that you start with your primary care physician and state the symptoms that you are experiencing.  They will then need to come up with a plan to treat the symptoms that does not involve breast reduction surgery initially.  If you do an internet search for insurance coverage criteria for reduction mammoplasty you will probably find something like I have typed below.An example of typical insurance requirements for coverage of breast reduction follows.Reduction mammoplasty for symptomatic breast hypertrophy meet the definition of medical necessity when all of the following criteria are met:A minimum 6 week history of at least 2 of the following that are unresponsive to conservative therapy (e.g., support bras, wide bra straps, analgesia, nonsteroidal anti-inflammatory drugs, physical therapy, exercise therapy, heat treatment, cold treatment)-Back pain-Neck pain-Shoulder pain-Paresthesias of hands or arms-Headaches-Intertrigo-Shoulder grooving from bra strapsANDGrams of breast tissue planned to be removed from each breast is at or above the 22nd percentile of the Schnur sliding scale, based on individual's body surface area

Miguel Delgado, MD · Answer

Insurance companies do not make it easy to get approval, however be persistent and you will probably get coverage. Some insurance companies require that you get your primary doctor to refer you to a plastic surgeon, sound like yours does. Your primary doctor and your plastic surgeon will probably be able to help you go through  the process, be patient, the rewards are great! Good luck.

Glynn Bolitho, PhD, MD, FACS · Answer

You should see your primary physician and have your symptoms documented.  Most patients seeking a breast reduction experience physical symptoms such as shoulder grooving, back and neck pain, irritation in the crease under their breasts. It would be helpful to then have your primary doctor recommend that you see a plastic surgeon.  Remember, insurance companies are not in the business to pay claims and many will also need supporting documentation such as minimum grams of tissue removed with supporting pathology report.  Best of luck to you.

Kris M. Reddy, MD, FACS · Answer

Insurance companies will make it increasingly difficult to get coverage for breast reduction. Each insurance company has different criteria so you should check with your company. Typically, you will need a letter from your primary physician indicating that the surgery is medically necessary and detailing steps you have taken prior to the physician coming to the conclusion that the surgery is medically necessary.

Steven Wallach, MD · Answer

Insurance companies make it harder and harder to get approval for breast reduction surgery. Each company is different so you are best asking your insurance company what they specifically need.

Paper trail for breast reduction

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Paper trail for breast reduction

Answers (6)

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Answer: Paper trail for breast reduction

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