Steps to take for Cigna to cover breast reduction?

Question

I was told to get two letters from my Dr. So that it can be sent to my insurance Cigna that I've always had back, neck, and shoulder pain. I seen one of my Doctors and I got one letter. Now I was told that my insurance does not cover breast reduction I am very depressed and am not satisfied with what the insurance is doing. How would I go about getting my insurance Cigna to cover my breast reduction? Please let me know because I can't take this pain anymore

Frank J. Ferraro, MD · Answer

Thank you for the great question. We work with our patients to get the procedure approved by forwarding the facts of the case to the insurance carrier. If your plan does not cover the procedure you can switch insurance carriers during open enrollment, work with your human resources department or finance the costs and pay it off monthly. Our office can assist but you need to know all the details and all your options.

Jennifer Greer, MD · Answer

From what you said in your question, there could be two things going on:1) Cigna will not cover breast reduction because they don't consider it medically necessary. If this is the case, your plastic surgeon may be able to appeal the decision.2) Breast reduction is an excluded procedure under your insurance. You can find this out by calling your insurance company. If breast reduction is excluded under your current policy, your only choice is to get a new insurance plan or pay for surgery out of pocket.Best of luck!

Tracy Pfeifer, MD · Answer

Thank you for your question.  It is very frustrating sometimes to deal with the insurance companies.  First, you must find out if your plan covers breast reduction.  You indicated that it does not.  If your plan does not cover breast reduction, you could look into selecting a plan that does include breast reduction.  If this is not an option, some plastic surgeons offer patient financing such as Care Credit.  Another option if paying for the surgery is not an option for you, is to have a consult at a plastic surgery resident clinic and have your surgery through the clinic.  The surgery is done by residents overseen by attending plastic surgeons.  Such programs in New York City include New York University, Manhattan Eye Ear and Throat Hospital, among others.  If your insurance does include breast reduction as covered benefit, your plastic surgeon's office may be able to help you with the necessary paperwork.  In my office we have an insurance coordinator to help patients get approved for breast reduction.  Hope this helps.Tracy Pfeifer, MD

Robert L. Kraft, MD, FACS · Answer

Cigna does cover reduction but it takes more than two letters! You must fall within their BMI criteria and establish that conservative medical management over a period of months has not alleviated your symptoms. Wirh Cigna it is unlikely that reduction is an exclusion from coverage. We see this more in union self-funded plans.Cigna posts its standards on its website so you should be able to access the relevant information on your own. Good Luck!

Steven Wallach, MD · Answer

If your insurance company will not cover your breast reduction then you will have to self-pay for it. Good luck with you decision to move forward.

William Lambeth, MD (retired) · Answer

First get your benefits dept. to check if breast reduction is a covered service.If so, you need documentation of failure of conservative treatment to resolve back and neck pain caused by having large breasts. most people take pain meds, use custom bras,and fail to respond to physical therapy.

Steps to take for Cigna to cover breast reduction?

Answers (6)

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