I have been to the dr so many time with back pain and rashes under breast and above my pelvic bone because of sagging breast and saggy abdominal skin. I’m 5’1 and weigh 123 my breast are 36dd and are heavy. I don’t know how to go about asking my insurance company to cover something like this.
July 15, 2019
Answer: Insurance coverage: breast reduction/panniculectomy Irregardless of the procedure, the key to insurance coverage is demonstration of medical necessity.Candidates for reduction will typically have documented evidence of neck/back and shoulder pain as well as rashes and bra strap grooving attributable to the increased breast weight. They will often demonstrate that these symptoms have been resistant to more conservative measures like therapy, weight loss and pharmacologic intervention. In addition to establishing a case for medical necessity, there are also requirements for resection weight (when covered by insurance). This may be a standard "500 gm per side" stipulation or a more variable standard based upon body surface area/Schnur scale. It is important to realize that these weight requirements can occasionally exceed your goals for size reduction. Insurance coverage is contingent on these requirements being met, thus cosmetic concerns become secondary(i.e. cup size goals).With regards to panniculectomy, similarly, the key is demonstrating medical need. In this case, that means intractable rash and skin breakdown secondary to skin apron and overhang. It is also important to remember that this is not a tummy tuck but rather an excision of hanging skin and the degree of resection will be determined by the level of the intertriginous fold/crease. Anything below that crease will be removed, everything above remains. Based on your photos and narrative, you might be a better candidate for abdominoplasty (which will not be covered). As always, discuss your concerns with a board certified plastic surgeon (ABPS). Donovan Rosas MD Board Certified by the American Board of Plastic Surgery Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons RealSelf Top 100 RealSelf Hall of Fame
Helpful 1 person found this helpful
July 15, 2019
Answer: Insurance coverage: breast reduction/panniculectomy Irregardless of the procedure, the key to insurance coverage is demonstration of medical necessity.Candidates for reduction will typically have documented evidence of neck/back and shoulder pain as well as rashes and bra strap grooving attributable to the increased breast weight. They will often demonstrate that these symptoms have been resistant to more conservative measures like therapy, weight loss and pharmacologic intervention. In addition to establishing a case for medical necessity, there are also requirements for resection weight (when covered by insurance). This may be a standard "500 gm per side" stipulation or a more variable standard based upon body surface area/Schnur scale. It is important to realize that these weight requirements can occasionally exceed your goals for size reduction. Insurance coverage is contingent on these requirements being met, thus cosmetic concerns become secondary(i.e. cup size goals).With regards to panniculectomy, similarly, the key is demonstrating medical need. In this case, that means intractable rash and skin breakdown secondary to skin apron and overhang. It is also important to remember that this is not a tummy tuck but rather an excision of hanging skin and the degree of resection will be determined by the level of the intertriginous fold/crease. Anything below that crease will be removed, everything above remains. Based on your photos and narrative, you might be a better candidate for abdominoplasty (which will not be covered). As always, discuss your concerns with a board certified plastic surgeon (ABPS). Donovan Rosas MD Board Certified by the American Board of Plastic Surgery Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons RealSelf Top 100 RealSelf Hall of Fame
Helpful 1 person found this helpful
July 13, 2019
Answer: Unlikely to Cover Hello,Your appearance does not warrant insurance coverage, regardless of your symptoms. You are not a candidate for a panniculectomy, and your breasts are relatively small for a medical breast reduction. However, you would get a great result from liposuction and a tummy tuck, as well as a breast reduction, i.e. cosmetic surgery.
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July 13, 2019
Answer: Unlikely to Cover Hello,Your appearance does not warrant insurance coverage, regardless of your symptoms. You are not a candidate for a panniculectomy, and your breasts are relatively small for a medical breast reduction. However, you would get a great result from liposuction and a tummy tuck, as well as a breast reduction, i.e. cosmetic surgery.
Helpful