41 y/o, 5'5", 158 pounds (tgoal weight of 150). My doctor said my measurements put me at a 38 F, but I often wear DDD bras comfortably with no "spillage". The doctor requested 550-600. Insurance will only cover it if it's at least 745 grams. That's more than the doctor, who actually EXAMINED me, thinks is necessary. They've based this on my height and weight, but they won't give the ratio they used to calculate. I think 745 grams seems like a lot. Is this amount often taken from a 38 F patient?
April 12, 2017
Answer: Breast Reduction and Insurance The equation that the insurance company uses is usually based on your height and weight. They calculate the body surface area (BSA) and based on a sliding scale, determine the amount of breast tissue that needs to be removed in order for them to consider it medically necessary.Not that there is much difference in 100 grams when we are talking about 600 vs 700, but unfortunately they are sticklers and that is what they go by. The one thing you don't want your surgeon to do is to be restricted to a certain amount and have to remove that amount in order for insurance to cover the procedure.At times we see patients that don't qualify for insurance paid reduction and choose to pay for the procedure themselves. They wind up still very happy and have an improvement in their life and daily living. Hope that helps.
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April 12, 2017
Answer: Breast Reduction and Insurance The equation that the insurance company uses is usually based on your height and weight. They calculate the body surface area (BSA) and based on a sliding scale, determine the amount of breast tissue that needs to be removed in order for them to consider it medically necessary.Not that there is much difference in 100 grams when we are talking about 600 vs 700, but unfortunately they are sticklers and that is what they go by. The one thing you don't want your surgeon to do is to be restricted to a certain amount and have to remove that amount in order for insurance to cover the procedure.At times we see patients that don't qualify for insurance paid reduction and choose to pay for the procedure themselves. They wind up still very happy and have an improvement in their life and daily living. Hope that helps.
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April 13, 2017
Answer: Breast reduction Unfortunately the insurance industry sets the standard for the amount of grams removed. As you stated they base it on your height and weight. You can try and appeal their decision but they are not likely to approve. Good luck.
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April 13, 2017
Answer: Breast reduction Unfortunately the insurance industry sets the standard for the amount of grams removed. As you stated they base it on your height and weight. You can try and appeal their decision but they are not likely to approve. Good luck.
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