Are you unable to find a bra that will give you enough support?
In order to have your health insurance pay for your breast-reduction surgery, you must demonstrate to the insurance company that you need the surgery for health reasons and not for cosmetic reasons. It may take more then one submission to your insurance company to convince it that your breast size is inhibiting your ability to live a normal, pain-free life.
Necessity
Breast-reduction surgery is generally perceived as a cosmetic surgery to insurance companies, but perhaps you are among the number of women who need breast reduction for health reasons. Breast-reduction surgery is highly suspect to insurance companies and you and your plastic surgeon must document that your planned surgery is done for medical and not cosmetic reasons.
Breast Size
There is no specific breast size that determines your eligibility for breast-reduction surgery. Normal breast size varies wildly among different women. The American Society of Plastic Surgeons has a list of factors that it uses to determine whether the breast reduction surgery is an elected cosmetic surgery or a reconstructive necessity that should be covered by a third party, i.e, your insurance company. These guidelines include the breasts inhibiting normal activities, poor posture caused by the weight of the breasts, pain in the back, pain in the shoulders, pain in the neck and pain in the breast.
Weight Loss
The insurance company will not cover your breast reduction if it is not documented that you have tried other methods of breast reduction. If you are overweight for your height, your insurance company may need documentation that you have tried to lose weight and have either succeeded but not lost breast mass or that you are seriously inhibited from exercise by your breast size. You should also list any other ways you have tried to alleviate pain or symptoms caused by your large breast size.
What to Claim
Your surgeon needs to claim that you fall under the criteria of the American Society of Plastic Surgeons for women who need breast reduction for their health. You need to submit letters from your doctor claiming that he believes your symptoms are caused by overly large breasts and that surgery will relieve these symptoms. You will also need documentation on other methods you have tried. Although you may know in advance that other methods such as weight loss or physical therapy will not achieve the results you need, you still need to document these efforts for the insurance company.
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Appeal
Many patients are turned down when they first submit claims for breast-reduction surgery. Appeal letters can be written. Detail the ways that your breast size is inhibiting you from having a normal lifestyle. Some examples might include: lower back and shoulder pain, injury to the spine and emotional pain and embarrassment due to overly large breasts. The American Society of Plastic Surgeons also recommends that photographic documentation also should be sent to the insurance company. The patient will have to sign a photograph waiver.
Tags: insurance company, breast reduction, breast size, have tried, your breast, American Society, American Society Plastic
