What do I do about my breast reduction being denied when I so clearly need it?

Question

I have a 34 band size and i'm a K cup. I'm in so much pain, I can't breathe or sleep properly, my chest is numb, can't sit up straight or move right, I can't participate in life. Insurance didn't give a reason. The surgeon said she'd take around three pounds from each boob, so that meets the removal requirements - they've also rejected all my appeals without a reason. We have Anthem BCBS. I can't pay the 30k out of pocket - that's a whole year of college tuition, but I need this. Thank you

Jimmy S. Firouz, MD, FACS · Answer

I’m sorry to hear that your insurance has denied your breast reduction. It seems that the best possible option for you will be to pay out of pocket to have the procedure done, and have your surgeon give you all the documents you need to submit to insurance to get reimbursed for the procedure. There are many board certified plastic surgeons that do this procedure for under $30,000, as you had mentioned this is a very high price. Best of luck!

Seth Jones, MD · Answer

Unfortunately this is a battle we fight on a daily basis with insurance companies.  They have the ultimate say basing their decision on a mainly a BMI chart and your presenting symptoms (neck pain, shoulder grooving, breast pain).  Your physician can usually do a peer to peer and advocate to you.  The other thing is the out of pocket expense of 30k is way up there.  You can shop for a much more reasonable price like 7-10k if it comes down to an out of pocket expense

Christina Y. Ahn, MD · Answer

Some insurance companies have contractual parameters that deny any non-cancer related breast reduction surgery regardless of medical eligibility. Find out first if this is the case, then re-appeal with more supportive documentation. If denied, wait for open enrollment and choose a plan with better coverage.

Steven Wallach, MD · Answer

Each insurance company is different. If they do not want to approve it then your only other option is to pay for it yourself.

Ronald V. DeMars, MD (Retired) · Answer

You misunderstand insurance companies, they exist to make money for their investors by selling a product, insurance. The more money they take in and the less they pay out, the happier they are. Breast Reduction is an operation they frequently will say they cover, but when you ask for coverage, they deny it. But $30k for a breast reduction is outrageous. Most of our patients are not covered by insurance and fees for the surgeon and the anesthesiologist and the surgery center combined are less than $10k. It is outpatient surgery, we haven't admitted a patient to the hospital for breast reduction in well over 20 years. Look around for a more reasonable price but be sure you are seeing a board certified and experienced plastic surgeon.

What do I do about my breast reduction being denied when I so clearly need it?

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Answer: What do I do about my breast reduction being denied when I so clearly need it?

Answer: What do I do about my breast reduction being denied when I so clearly need it?

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What do I do about my breast reduction being denied when I so clearly need it?

Answers (5)

Answer: Breast reduction

Answer: Breast reduction

Answer: What do I do about my breast reduction being denied when I so clearly need it?

Answer: What do I do about my breast reduction being denied when I so clearly need it?

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Recommended reading

Everything you need to know about Breast Reduction

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