American Society of Plastic Surgeons
For Medical Professionals
 
Amy0612
one year ago
Answered

Insurance

My doctor that I had for many years is no longer at the practice, and all medical records were disposed. I’m in need of reduction mammaplasty for YEARS now what can I do to get it approved?

Procedure: Breast Reduction
Location: Tucson, AZ

Replies 3

Tracy McCall
ASPS Surgeon

Find a board certified plastic surgeon in your insurance network. There are plenty in Arizona. Call the office and ask about getting a breast reduction. You can find plastic surgeons in your area on this website. You should also get a new primary care doctor.

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Rahul Vemula
ASPS Surgeon
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Medical records are usually held on for 7 years. If it’s been greater than 7 years since the doctor left the practice you may be out of luck to get those records

Also, please look at the summary plan description (SPD) of your specific insurance plan. It will tell you exactly what the requirements are for a breast reduction. Sometimes you may have a plan exclusion where they won’t cover it under any circumstance.

It is also imperative to follow the requirements of the insurance company for a breast reduction to the letter. The insurance companies will try to do anything possible

To deny coverage.

Best wishes

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Alfred Antonetti
ASPS Surgeon

medical records are required to be kept for seven years, at least that is the law here in Texas. For a breast reduction to be approved by insurance you must meet a certain number of requirements. The only thing you can do is to consult with a local ASPS certified surgeon who will tell you if you qualify or not. Your medical records are not likely to be needed.

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