Steps To Getting A Breast Reduction Covered By Insurance

September 27, 2021 Post a Comment

Most insurance providers will want you to get preauthorization for a breast reduction procedure. You need real proof.

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Often times insurance company will need documentation of back pain shoulder pain photos your height and weight size of your breasts and proposed weight of breast tissue that would be removed.

Steps to getting a breast reduction covered by insurance. Insurance companies need to be convinced that breast reduction is medically necessary. However most insurance plans will consider your documented symptoms the duration of symptoms and how your symptoms may affect your quality of life. Quality of life indications include chronic back or shoulder pain.

You must have the mandatory number of grams of tissue removed from each breast by an in-network physician at a facility that participates in the particular plan for which youre covered. A cosmetic indication may simply be the desire to have breast volume that is more proportional to your body size. If your breast reduction gets approved your insurance company will cover the cost of your surgery assuming you dont deviate from the pre-approved plan.

Conversely many patients believe if a procedure is considered cosmetic it is not a medically indicated and covered procedure. If your insurer does not provide coverage for breast reduction you might not be covered for a plastic surgery consultation either. Depending on your insurance provider this will involve getting a recommendation from your surgeon that you are a good candidate for reduction mammaplasty.

Each insurance company requires a certain amount of criteria in order for a patients breast reduction surgery to be covered. William Lambeth MD retired March 3 2015. Most people take pain meds use custom brasand fail to respond to physical therapy.

And convincing them requires more than just a doctors recommendation. Your surgeon will take photos of your breasts and breast tissue. It is universally believed by patients that if a surgery is considered reconstructive it is medically indicated and covered by health insurance.

Insurance coverage Breast reduction may be covered by insurance if you meet certain critera specified by your insurance coverage. Some insurance companies cover part or all of the cost of breast reduction surgery if youre having it to relieve physical problems like back pain or skin problems. Again that price may be different based on your coverage.

If you are considering breast reduction surgery first read your insurance policy. Additionally they usually require for a certain percentage or amount of breast tissue to be removed in order to qualify. Check your insurance policy to see if such a procedure could be covered or partially covered to alleviate symptoms you are experiencing.

Your surgeon can help you gather the necessary information and measurements to send to the insurance company before surgery. If your insurer lists reduction mammaplasty as a policy exclusion you may not even get coverage for a consultation to discuss whether surgery is appropriate for your symptoms. Breast reduction can be considered for quality of life as well as for cosmetic reasons.

To get it I went. Prices will be different but the national average for a breast reduction procedure itself not including hospital stays or anesthesia costs is around 7000 - 8000 out-of-pocket before insurance is applied. Sometimes this is covered by insurance.

Discuss your concerns with your primary care provider. First get your benefits dept. To check if breast reduction is a covered serviceIf so you need documentation of failure of conservative treatment to resolve back and neck pain caused by having large breasts.

Getting Your Procedure Covered If you are suffering from unpleasant symptoms that can be attributed to your oversized breasts speak with your physician and contact your insurance company to determine your eligibility for coverage. Find out about the copay or deductible. The facility where you choose to have the breast reduction done will know this criteria or have a billing associate that can check for you.

While the process can vary depending on the insurance provider patients interested in having breast reconstruction surgery covered by their insurance will typically have to furnish their insurance provider with a letter of medical necessity which states that procedure is required in order to resolve an underlying health problem. Schedule your consultation Most insurance plans need to know that your procedure is considered medically necessary to be able to cover your breast reduction. Call your insurance company to see if a pre-authorization letter is needed for breast reduction surgery.

Breast reduction and health insurance.

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