Are you eager to know how to get your insurance to pay for breast reduction? If yes, request the surgeon write a letter describing your physical findings and symptoms as a patient. This estimates the weight of the breast to be removed. This, therefore, requires coverage. This has to be done before the schedule of surgery.
Consulting with a doctor is a must-thing to do. This is to know you make a perfect candidate for the surgery. Remember as well that breast health is very different for every woman. So speak only with experts for your concerns and questions.
Below is more information to keep in mind about the procedure and the insurance to pay for it.
As Medically Necessary
In general, breast reduction is covered if it’s considered medically necessary. Nonetheless, this is to be pursued the patient has proved to her doctor the underlying condition. And it would help if you remediated this by going through a corrective procedure. Patients must also have a predetermined insurance threshold. This way, the surgery will go under the insurance policy.
Breast Reduction Surgery Be Like
The breast reduction surgery will be carried out in an outpatient or hospital kind of surgery setting. So far, various options are there for incisions to be used. The surgeon will consider your characteristics as extra skin or sag, breast size, and skin elasticity. You will need to wear a support bra after the surgery. This is until the dressings are finally removed. After that, some doctors won’t require you to wear them continuously. Or, this could be at a specified time only.
Once you’re done with removing your dressings, you’re already free to wear a comfortable bra. Don’t wear a bra, including an underwire, for six weeks.
The recovery period from home will roughly be two to six weeks. Therefore, it’s an excellent time to seek help for completing household chores. The limits for physical activity will include not lifting more than ten pounds for two weeks. Do not also engage in exercise or strenuous activity for two weeks. For example, don’t reach or stretch over your head for two weeks. Afterward, gradually increase your physical activity. Use your upper body muscles being the last thing to add in four to six weeks. This is right after the surgery.
Probable Risks Of Breast Reduction
Breast reduction surgery is indeed a safe procedure. The risks of infection, healing and bleeding issues are very common to surgical procedures. But, they may be low with breast reduction. The feared complication is the risk of compromise to the areola and blood supply in the nipple. But, this is somehow a very and sporadic case. The procedure might affect your supply of milk if you breastfeed. That’s also if you want to get pregnant. In some studies, it’s indicated that other women have to supplement formula for breastfeeding. It’s pretty hard to predict who will be supplementing or will not. The thing is that those who have their breasts reduced will produce breast milk. Others will have to supplement the formula.
Ways To Get Your Insurance To Pay For Breast Reduction
The process of getting insurance varies depending on the insurance company. Follow the ways below to make it easier on your part. Here’s how to get your insurance to pay for breast reduction:
#1. Preparing a medical letter
Prepare for a medical letter as it’s a necessity. This must typically be furnished with the insurance provider. This must state the procedure is needed in resolving the current health issue. The insurance providers will be requesting six to twelve months of complete documentation. This will include treatment with the dermatologist, chiropractor, physical therapist, an orthopedist. This is to make sure the treatments go under the ruling before the approval of the surgery.
#2. Writing a letter of request
Write a letter of request stating what is needed for approval. This is considering your insurance provider that speeds up the process. This must be presented before the breast reconstruction surgery. This is needed because of the criteria for approval for every insurance company.
#3. Submitting required docs
Submit the needed documentation with an average time of turnaround of three to six months. In this timeframe, it enables an insurance provider to have discussions with the physician. This comes with seeking second opinions too from healthcare providers. These healthcare providers include chiropractors. This is to confirm the needed medical surgery best. In addition, it’s a must to inform the physician regarding your intent to get the procedure covered by insurance. This will ensure the medical letter is necessary. You will also send other documents to the insurance provider.
Things Expected During the Surgery
Breast reduction surgery is always done with general anesthesia. It’s also carried out in a hospital or an outpatient facility. The surgeon will be using 1 of the two methods during the procedure. This will help remove the excess fats. This also includes the overall size of the breast of the patient, liposuction, or surgical incision. The attending surgeon will be making an incision throughout the areola. This is the ring pigmented around the nipple. It then goes down the length of the breast before fats, tissues, and skin are removed.
In effect, this best reduces the breast and its total size. The breasts will be shaped again before the repositioning of the areola. This is considering the newly and resized breast.
You will reshape the breasts while the areola is repositioned. This is to best complement the new size of breasts.
Other Conditions Covered By Insurance For Breast Reduction
Breast reduction surgery is among the cosmetic procedures covered by health insurance. The requirements may vary by insurance plans and company. However, it should usually be that a woman experiences the following:
- Neck, shoulder, back, or head pain not diminished by the regular therapist visits
- Large breasts could be reduced by three cups sizes or even more. This could be 500grams or more.
- Dermatological issues like painful grooves are not treated or cured correctly. These are found in the shoulders because of wearing two bras or bra straps that support huge breasts or even rashes.
- An individual does not maintain a healthy weight of the body because of physical exercise limitations. Or, it could be that one does not play sports because of the breast size.
- Weight loss is documented, and it does not improve the size of the breast. This way, a woman will get the relief she has possibly needed.
Submit a pre-authorization letter before the insurance company. This should go to the general doctor or the plastic surgeon. This will somehow require photos that document issues like the massive breast look and the skin rashes. Others who could pay for the procedure privately can wait. They don’t seek more pre-authorization from the insurance company. Instead, they wait until the procedure is completed to choose the plastic surgeon freely. This is also to know the amount of breast weight or tissue to be removed.
Insurance policies would demand a specific amount of tissue to be approved. The general doctor or plastic surgeon will submit photos before and after as part of the documentation to the insurance company. This includes the health issues that you are also experiencing.
Cost Of Breast Reduction With No Insurance
The breast reduction surgery process covered by the insurance saves you money. Just provide a claim that is approved. This is based on the data compilation of the American Society of Plastic Surgeons. The cost of breast reduction surgery on average is 5,482 dollars. This also includes more additional fees like:
- Anesthesia
- Facility costs
- Prescription medications for post-surgery
- Surgeon fees
Oh, you may also want to know how much does a Breast MRI cost without insurance.
It’s A Wrap!
Don’t hesitate anymore but keep the pointers mentioned on how to get your insurance to pay for breast reduction. Then, live the best of your life by getting your heavy or oversized breast tissue removed. The caring staff around will navigate throughout the process. Reach out and then schedule your breast reduction consultation. You may want to read about how much does a Bactrim cost without insurance and how much does Penicillin cost without insurance.