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Old 01-17-2008, 06:51 PM   #1
Join Date: Jan 2008
Location: emmaus, pa
Posts: 1
rachael30 HB User
how to get insurance to pay for breast reduction

how to get insurance to pay for breast reduction my breast are a size 36dd and i always have pain in my back

Old 01-31-2008, 05:15 PM   #2
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Join Date: Jan 2008
Location: us
Posts: 10
33itsjustme HB User
Re: how to get insurance to pay for breast reduction

Originally Posted by rachael30 View Post
how to get insurance to pay for breast reduction my breast are a size 36dd and i always have pain in my back

Hi Rachael, You will want to, if you haven't already, ask your insurance company what their criteria would be to cover the surgery. They should have some example, a formula or something that says when they feel someone would qualify for the surgery because it is medically necessary. If you don't meet that criteria, then you will want to inquire on the appeal process of the insurance company. If you do not meet the criteria but you are able to show why your circumstances would still warrant the surgery, they may cover it. Hope that helps.

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Old 02-29-2008, 08:47 AM   #3
Join Date: Oct 2007
Location: TX
Posts: 85
Dee2000 HB User
Re: how to get insurance to pay for breast reduction

Most insurance companies cover a reduction if the surgeon removes at least 454 grams of tissue on ONE breast - or one pound. Your doctor should have given you a range in the consult. Also make sure you include any physical therapy or back pain meds you've received in the past and for how long.

I know about removal of 11 lbs off a woman's breasts, and her insurance denied it stating she was just overweight....go figure. She was a morbidly obese woman, but the large breasts were STILL causing back pain. They can always come back to deny it later so be careful. The breast tissue is sent to a lab and can be deemed just fatty tissue. They use all sorts of reasons and sometimes site the overweight issue - that's why they ask you for your height/weight preop to the insurance company from your doctor's office.

Last edited by Administrator; 03-22-2008 at 08:18 AM. Reason: Read the rules.

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