Breast Reduction and Insurance
By Kris M. Reddy, MD FACS
Published on August 17, 2010
The process that plastic surgery patients must undergo in order to receive insurance reimbursement for the breast reduction procedure can be quite frustrating. Different insurance companies generally have different requirements and there are a series of questions that must be answered prior to beginning the insurance process. Some of these questions include:
1. Have you experienced persistent symptoms in at least two of the anatomical body areas below, affecting daily activities for at least one year:
- Pain in upper back
- Pain in neck
- Pain in shoulders
- Painful kyphosis documented by X-rays
- Pain / discomfort / ulceration from bra straps cutting into shoulders
2. Have you had a mammogram within the last year?
3. Have you tried any of the following therapies for three months or more?
- Supportive devices (e.g., proper bra support, wide bra straps)
- Analgesic / non-steroidal anti-inflammatory drugs (NSAIDs) interventions
- Physical therapy / exercises / posturing maneuvers
4. Have you seen a physician for the symptoms you have experienced? When?
Your physician must also be able to document symptoms such as back and neck pain, headaches, and other problems associated with overly large breasts. Surgeons also needs to ensure that the estimated reduction is consistent with the insurance company's requirements for your BMI.
Dr. Kris Reddy offers breast reduction procedure to patients seeking treatment. With breast reduction surgery, surgeons can enhance your overall appearance by making your breasts more proportional to the rest of your body. Large, sagging breasts often interfere with normal physical activities. They can cause back pain, postural problems, deformities of the back and shoulders, skin rashes, and breast pain. In addition to alleviating these physical problems, breast reduction improves the shape of your breasts and nipple areas. The operation usually is performed under general anesthesia and is generally done on an outpatient basis. During the procedure, excess breast tissue and skin is removed, your nipples and areolas (the pigmented skin surrounding the nipple) are repositioned, and your remaining breast tissue is reshaped.