Insurance and Breast Reduction

large-breastsBreast reduction has become one of the leading procedures performed by plastic surgeons.  But it’s interesting that patients on and in my own office aren’t really sure if they are a candidate for breast reduction or if there insurance company will pay.  So much misinformation is on the web that this is understandable.  Let’s not kid ourselves the reality is that insurance companies are publicly held companies that only interested in making profits and dividends for share holders.  The less they pay out in claims the better their bottom line.  So they don’t want to pay for breast reductions because, for the most part, they consider them cosmetic.

To start with some companies insist on removal of at least 500g (grams) of tissue on each side.  Other companies require more; I had one company insist on 900g per side!  This means that should less be removed they won’t pay.  And unfortunately 500g is significantly different between patients.   In addition instead of a breast reduction being a cosmetic/aesthetic procedure it’s an accounting equation.  Next prior to “preapproval”, whatever that means, most insurance companies require that the patient see their primary care physician, on at least 3 separate occasions, specifically for neck and back pain, intertrigo, shoulder grooving, headaches and any other symptom related to large breast size.   Next the patient must have the physician document that she has been properly fitted for a bra, wears that bra and possibly a second.  Next, the patient must have documentation that she has undergone intense physical therapy to strengthen neck and back muscles, has used multiple medications for pain/symptom relief and has achieved weight loss.

Finally, to add insult to injury if the insurance company does pay the physician it is usually only 15-20% of their fee.  Therefore, I am a strong believer in breast surgery as an artistic endeavor and not just to “fill the quota” for tissue.  So if you would like to have pretty breasts that are proportionate to your body after breast reduction please click here or contact our office at 703.752.6608 for a complementary consultation with Dr. Christopher Hess.

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