Health insurance and breast reduction
Patients believe that any surgery considered reconstructive is covered by insurance if it is medically necessary. Many patients also believe that a procedure is not covered and medically necessary if it is classified as cosmetic.
Breast reduction is considered cosmetic surgery for insurance purposes. However, the patient must prove that they have not had any health problems and have attempted to resolve them before the procedure can be considered corrective. After reaching the threshold, an insurance company might consider breast reduction a reconstructive policy and pay for it. The problem is the threshold may be different for each insurance company and insurance company reviewer. I think breast reduction surgery has been viewed as a hybrid procedure. The surgery is considered reconstructive when insurance covers the cost of the procedure. However, it is also cosmetic because patients are expected to have a high level of aesthetic expertise and beautiful results.
It is becoming more difficult for patients to get insurance coverage for breast-reduction surgery. Before they cover it, insurance companies often require documentation from 2-3 other specialists. Insurance companies often request documentation from a chiropractor, dermatologist, or physical therapist for 6-12 months.
What does this mean to a patient who has macromastia-related chronic health issues? This is a good time to keep track of the policies because the insurance company’s criteria this year may differ from next year.
If you believe you may be a candidate for breast-reduction surgery, you should contact your insurance company to request coverage. Each insurance company has its criteria and guidelines. For example, your neighbor may be eligible for the procedure through one insurance company, even though they have a less difficult situation. However, your answer may differ from theirs. It takes, on average, 3-6 months to prepare for breast reduction. This includes secondary consultations with other healthcare professionals and possible therapy (physical therapy, chiropractics).
What can you do? It would be best to immediately inform your primary care physician about any symptoms associated with your macromastia. Then, it’s always possible to begin the process. Contact your surgeon if you have questions about breast reduction or insurance coverage. They can help you navigate the process, so you get the care you need.
You may be considering insurance coverage for breast reduction.
It is not easy to lose weight in breasts, unlike other areas of our bodies. It’s a bit of a Catch-22. Many women who want to lose weight find that they can do all of the cardio exercises while maintaining their breast size. The catch is that having large breasts can cause pain while running or doing cardio exercises like running.
Cost is a concern if you’re considering breast reduction surgery. Many women are unaware that you should consider important factors when applying for a breast reduction through your insurance company. This option is perfect for women struggling with breasts that interfere with their daily activities.
The following are considerations if you want your breast reduction covered under insurance.
For neck and back pain, see a chiropractor or physical therapist
Many women are interested in breast reduction surgery because of back pain, neck pain, or general stress. It would be best if you first visited a chiropractor or physical therapist to address your pain. Make sure to mention that you are interested in breast reduction surgery to relieve your pain. Ask them to take a note in your patient file detailing your pain and discomfort. These visits will prove to them that your symptoms are causing you pain and that you have tried other remedies before deciding to go ahead with the surgery.
Talk to your Primary Care Physician
You must speak with your primary physician if you want the coverage to cover breast reduction. Your primary care physician will take note of the pain and discuss the long-term effects on your neck and back. In addition, minor pains like discomfort from bra straps digging into your skin should be included. It shows how serious you are about your health and not just looking for a breast reduction.
Talk to a plastic surgeon
A surgeon who specializes in breast-reduction surgery is available for you to meet. A consultation will show that you are proactive in gathering the information necessary to make informed decisions about surgery. A plastic surgeon can write a letter of medical necessity that will detail your history and the treatment and recommendations of other doctors. As part of pre-operative authorization, a plastic surgeon will also include the number of breasts to be removed, which is essential information for the insurance company.
Insurance companies may require pre-operative photos as part of the authorization process for breast reduction procedures. Each insurance company will inform the physician’s office if photos are necessary for pre-authorization.
Take note of specific activities affected by your breast size and pain.
Experiencing symptoms such as discomfort sitting at work with bra straps protruding into your shoulders is common. These aren’t medical signs that you have back pain. However, they give insurance companies a better understanding of why breast reduction insurance is important.
Breast reduction surgery can bring many benefits and help you lead a happier, more active life. If you have a breast surgeon who makes breast reduction regularly, they will work hard with you to get your insurance to cover the procedure. Your insurance company will approve the procedure if they have all the information about your case, including the pre-operative information and medical necessity. Insurance companies want to ensure that your surgery is not performed for cosmetic purposes.