How many referrals for breast reduction showing the medical necessity would you recommend?

Question

I am 26, had an overly large bust since 12. By some miracle, no stretch marks. At 120lbs, I was down to 34dd. I put on weight, have slowly been losing it, my chest is not getting smaller. Back pain is constant. my closest bras to fitting are 38Ddd. Running is difficult w/ size. I called insurance co, and to be approved, removal > 600 grams. I have an appt w/ gp, but is that sufficient? I am getting a little desperate, as my life is basically halted because of this. I would appreciate any advice.

Pedy Ganchi, MD · Answer

Hello,Every insurance plan has specific criteria for authorization of a breast reduction. Generally, they require proof of medical necessity over a period of time and documentation of all medical therapy that has failed (physical therapy for the back, analgesics, weight loss, etc.).  I  have found it beneficial to have multiple specialists (back, pain management, physical therapist and plastic surgeon) who can recommend this surgery as a means of treating your symptoms.  Of course some insurers also require a specific amount of tissue to be removed. Once the proposal and data (photos are often requested) are sent to your insurer, they will then determine whether your surgery is authorized.  Good luck!Warm regards,Dr, Pedy Ganchi                                                                                                                                                      Village Plastic Surgery

Karol A. Gutowski, MD, FACS · Answer

In most cases, one evaluation by a plastic surgeon should be enough for insurance approval. But it is up to you to check with your specific insurance plan.

Moneer Jaibaji, MD · Answer

Thank you for the question. This is a common question. If you have insurance and you are symptomatic; i.e. have neck, back and shoulder pain and you have documentation by your primary care physician, then I think you should try the insurance route. The plastic surgeon will submit all the information along with his examination findings. The insurance may approve the surgery or reject it. If the surgery was denied they will tell why it was denied.If you decide to pay for it, then you have to find a board certified plastic surgeon, this can be from the American Society of Plastic Surgery directory. Get a consultation, look at before and after photos and determine what you want.

Daniel Krochmal, MD, FACS · Answer

Thank you for your question.  I recommend getting a list of doctors in your area who take your insurance (your insurance company can provide this).  I would then ask friends/family/doctors (including your GP) for recommendations on which doctors to visit.  Check out their websites, read their reviews, and then go in for consultations until you find a doctor who you feel is right for you.  Your plastic surgeon will guide you from there.  A word of caution, insurance can be tricky, and the companies seem to be finding more and more ways to deny patients (like needing documentation of back pain not responsive to physical therapy).Best,Dr. Dan KrochmalMAE Plastic SurgeryNorthbrook, IL

How many referrals for breast reduction showing the medical necessity would you recommend?

Answers (4)

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