Is Breast Reduction Covered By Health Insurance?

Is Breast Reduction Covered By Health Insurance?

The commonly known procedure breast reduction surgery is indicated for treating symptomatic macromastia (large breasts). This procedure is also known as the reduction of mammaplasty. Neck, shoulder, and back pain caused by the weight of excessively large breasts on the musculoskeletal system are mostly experienced by the patients as common symptoms. Other symptoms may include chest pain and dermatitis, or a rash under the breasts.

The general impression is that the proposed surgery is automatically covered by a Medicare plan but to get medical insurance for such procedures is a little tricky as it might be mistaken as a cosmetic procedure. Complete medical history is a must before applying for insurance which has several checks on previous treatments and symptoms faced by the patient. It is usually checked if the patient also had no referral for physical therapy, chiropractic treatment, orthopedic counseling, or dermatological examination. In many procedures, this lack of a treatment history may not be a problem. But in the case of a breast reduction, which, depending on the patient and health insurance expert, can be viewed as cosmetic or reconstructive, the patient’s lack of anamnesis would be problematic.

Once the requirements are met, you can re-apply for the cost of a reduction mammoplasty, but unfortunately, there is no guarantee that your insurance will cover the procedure. It is so important for patients to do their homework on their insurance coverage for any surgery before they see a surgeon. The answer to the question “Does the health insurance fund a breast reduction?” It can be very complicated and involve many variables.

Generally, patients are not aware of the requirements regarding these procedures and how to apply for the insurance funds. While the insurance companies consider these procedures as cosmetic, the patients suffer through heavy costs.

The patients only need to thoroughly research and follow the proper method to attain the insurance funds. For this, the patients need detailed medical history with all the previous checkup schedules, treatments, and therapy sessions (if any). This history detail can provide enough evidence for breast reductions surgery to be medically treated rather than a cosmetic procedure.

 

Breast Reduction and Health Insurance

Patients generally believe that an operation that is viewed as reconstructive is medically indicated and covered by health insurance. In contrast, many patients believe that a procedure that is considered cosmetic is not a medically indicated and covered procedure.

However, for insurance reasons, a breast reduction is usually considered a cosmetic procedure until the patient can demonstrate enough health problems and attempt to correct them in advance. Once the threshold is reached, the insurance company can consider breast reduction surgery as a reconstructive procedure for this patient and take it over. The problem is that the threshold can be different for each insurance company or appraiser.

Interestingly, breast reduction surgery has long been viewed as a “hybrid” procedure. It is considered reconstructive in trying to get insurance coverage for surgery, but it is also considered cosmetic in the sense that patients expect a thorough cosmetic experience from their surgery and its results.

In general practice, it is becoming more and more difficult to get insurance coverage for breast reduction. Insurance companies often require 2-3 documented reports from other referred specialists before considering coverage. In addition, insurance companies usually require 6 to 12 months of documentation and treatment by a physiotherapist, chiropractor, dermatologist, or orthopedic surgeon.

So now the important question is what does this mean for a patient who needs the procedure due to chronic macromastia health problems? During this process, stay updated on the policies as the insurance company’s criteria may get updated yearly and before applying for the coverage it is very essential to be aware of all the newly updated policies of your health insurance company.

If you are of the opinion that you are eligible for a breast reduction and apply for insurance cover from your health insurance company, it is important that you contact your health insurance company and request them to send you their coverage criteria in writing. Every insurance company has different and independent criteria and indications regarding several medical procedures.

While your neighbor on the street may benefit from going through a single insurance company with a seemingly less serious situation, yours may not give you the same answer. On average, it takes 3-6 months of preparation, including secondary consultations with other health care providers and possible therapy (physiotherapy or chiropractic), to be eligible for breast reduction coverage.

Furthermore, once you start experiencing any symptoms contact your medical examiner immediately. Always take experts’ opinions and then try and find out the best possible solutions regarding coverage of any surgical procedure. Always opt for a better insurance company by doing detailed research on their policies and coverage criteria to avoid any last-minute hazards.

How do you deal with that? Let your doctor know as soon as possible of any symptoms that might be related to your macromastia. It’s never too early to start the process. Contact your plastic surgeon’s office with any questions about breast reduction surgery and your insurance coverage. They can try to walk you through the process so that you can get the care you need.

Lastly, your health must always be on the top of your priority list. Regular checkups can help you avoid any major issues in the upcoming future. Several health insurance companies cover these kinds of procedures with minimal documentation and medical history if you are already conscious enough to schedule regular checkups.