American Society of Plastic Surgeons
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Erica86
one year ago
Answered

Breast reduction

Hello my name is Erica my question is why would I still need therapy for breast reduction surgery if my insurance cover the procedure I’ve already contacted them asking what are the requirements and I was told all I needed was an authorization from my doctor

Procedure: Breast Reduction
Type: Question

Replies 5

Nelson Castillo

Thank you for sharing your excellent question. Although an insurance company may “cover” a procedure it does not mean that they will pay for your operation. Typically in cases of a breast reduction, insurance companies want to see that patients have exhausted all conservative, non-surgical options before they give approval. One of those conservative treatments would be physical therapy. If you have attended sessions with little to no relief of symptoms, it strengthens your case for insurance to cover your operation . Hope this helps

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Susan Buenaventura
ASPS Surgeon
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Hello Erica, the " authorization" from your doctor may require physical therapy for approval for breast reduction. You can probably find the requirements online. All insurance companies are different. Remember that the person the patient speaks with at the insurance company is completely separate from the person who the doctor speaks with and who will approve or deny the claim. Congratulations on moving forward with your breast reduction!

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Jon Ver Halen
ASPS Surgeon
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Dear Erica,

Hello and thank you for your excellent question. In general, insurance companies will each have different criteria regarding when, and if, your procedure is covered. 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. 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!

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Gary Culbertson
ASPS Surgeon

Erica,

Thank you for this question on insurance coverage. Your insurance company is correct you require a visit, evaluation & a request from your surgeon for pre-authorization or pre-approval for your breast reduction. Most insurance carriers will have some document regarding what they consider are the requirements for their clients to achieve to have this surgical procedure done. These are often available on line. These are very often different from one insurance carrier to another. Consider calling your insurance carrier back to obtain their criteria for approval for a breast reduction. In todays world insurance carriers dictate health care coverage not doctors. Best,

Gary R Culbertson, MD, FACS

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Joseph Thornton
ASPS Surgeon
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Hi Erica,

The best way to find out about "coverage" for a breast reduction is to setup an appointment with a board certified plastic surgeon.

The insurance company is looking for overall size of reduction in combination with medical symptoms of back and neck pain or shoulder pain, rashes under the breasts and difficulty with activities.

At times conservative treatments including physical therapy and medical creams can resolve the issues, and other times they do not.

We as most plastic surgeons have plenty of experience dealing with the process. Most women are extremely satisfied with this surgery.

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