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How do I start the process to see if my insurance will cover a breast reduction?

Patients who have very large breasts can have symptoms from the large breasts with neck pain, back pain, shoulder pain, bra straps digging into their shoulders, inability to find bras or clothing that fit appropriately, and difficulty exercising. They also may have yeast infections along the breast tissue folds and have to use powders or topical ointments. When a patient has the above symptoms as well as findings on physical exam that support the macromastia or excessively large breasts, a breast reduction surgery may be a procedure that is covered by insurance. breast reduction covered insurance can be tricky to ascertain depending on breast size and medical necessity.

Documentation of these issues is very important in sending information to the health insurance company for pre-certification. If the patient has seen their family physician or ob-gyn about some of these issues, documentation in a letter of support of the plastic surgeon and breast reduction surgery helps. If the patient has been to see either a physical therapist or a chiropractor for upper back, neck, or shoulder pain, or has tried physical therapy and strengthening exercises without improvement, documentation of these endeavors provided to the insurance carriers would also help. At the time of the consultation, we will review the symptoms or complaints that the patient has, the treatment that has been tried so far, do a physical examination with measurements, and discuss the pre-approval process with the insurance company.

Determining your breast reduction candidacy will include an evaluation of your body mass index, affected breast tissue, and body surface area. A reduction procedure can be combined with other surgical operations should the plastic surgeon deem it safe. When patients have healthy breast tissue and musculoskeletal systems, they are at a lower risk for complications if they choose to have breast tissue removed.

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