Any info on getting insurance to pay for breast reduction?

Published

I know there was thread on breast reduction sometime back. I'd like to know anyone's experiences getting their insurance to cover it. Isn't is usually about a years' worth of documented visits for back/neck/shoulder pain, etc? I know all insurance policies are different, but would like some feedback on what folks have had to do.

Up Vote Up Vote ×
Specializes in ER.
I know there was thread on breast reduction sometime back. I'd like to know anyone's experiences getting their insurance to cover it. Isn't is usually about a years' worth of documented visits for back/neck/shoulder pain, etc? I know all insurance policies are different, but would like some feedback on what folks have had to do.

I have never done the breast reduction thing, so I don't know how helpful this is, but I have had a case in which I had to fight the insurance company who thought that my surgery was purely cosmetic. I had my lower jaw resectioned to prevent TMJ, but they didn't want to pay because "an overbite is simply a cosmetic variant," meaning different people look different, get over it. I wasn't having any symptoms - yet, but my surgeon wrote a letter to the insurance company I had at the time (Trigon Blue Cross/Blue Shield) saying that I was showing the early stages of TMJ (I had jaw popping and occasional sticking), and that this was preventable by doing the surgery. The insurance didn't cover everything, but a good portion. My suggestion is to gather all evidence of medical problems your breast size has caused you from your doctors, chiropractors, massage therapists, etc., have a consult with a surgeon who can write a letter to your insurance company if he/she feels that the surgery would help your back/neck pain. Also, give your friendly insurance company a call to see what their policy on such procedures is. Some insurances cover a lot more than you would think - others, painfully not much. The more information you have (research from medical journals and reputable websites wouldn't hurt either) and the more convincing your case is, the more likely your insurance company will be to pay up. The last thing they want is someone going on disability and suing because they failed to provide preventative treatment. Be forceful and well articulated. If you seem to be a pushover, they will definitely push! Good luck, and I wish you all the best, and a speedy recovery from the surgery! :balloons:

Up Vote Up Vote ×
+ Add a Comment