What do I need to provide to my Medicaid HMO Humana Insurance for them to cover this procedure?
You need to provide a doctors note from your primary provider documenting irritation under your breasts requiring treatment. Also you need to provide the plastic surgeon’s note detailing your history, attempts at weight loss, use of supportive garments, physical therapy. The note should also include any changes in your spine due to the weight of the breasts. Some insurers also want a calculated amount of tissue from the breasts according to something called the Schnur scale. Your plastic surgeon will know how to do this. Photos are also required in most cases. Good luck!
Hello and thank you for your excellent question. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. In general, you should contact your insurance company directly to see 1) if they cover breast reduction surgery, and 2) under what conditions. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!
in my 33 year experience Medicare or Medicaid will not cover the fees for elective breast reduction surgery today. I have preauthorized this surgery in the past for my patients only to be denied payment after I performed successful surgery.
I wish you luck in trying to get this work performed. My best advice is that this a cosmetic procedure which is paid for out of pocket. Take the advice given here from the other doctors which is good and optimistic and see what happens. Good Luck.