Breast reduction surgery is an option for some women whose breast size is disproportionately large compared to the rest of their body, and in some cases, weight loss can also lead to a decrease in cup size. While a larger cup size can be appealing to many people, it can also cause serious health complications. Over the last four decades, the average size of a woman’s breasts in the United States has steadily increased, with a rise from 34B in 1983 to 34DD in 2013.
Examine the factors that may necessitate an individual to undergo breast reduction surgery and ascertain whether private health insurance offers coverage for the costs of the procedure.
Why You May Need a Breast Reduction
Common symptoms that may indicate the need for a breast reduction surgery include experiencing discomfort in the back, neck, and shoulders, experiencing indentations from bra straps, struggling to find properly fitting clothes, and dealing with self-esteem issues. The typical procedure for this surgery involves creating incisions around the areola, removing excess tissue, reshaping the breasts, and repositioning the nipples. It is crucial to have a consultation with a qualified plastic surgeon to discuss your goals and expectations, as well as the potential risks and complications associated with the surgery. Overall, a breast reduction surgery has the potential to greatly alleviate both physical discomfort and emotional well-being concerns for many women.
Men who suffer from gynecomastia, which is often caused by hormonal disruptions, can also undergo breast reduction surgery to alleviate the enlargement of breast tissue.
Does Insurance Cover Breast Reduction?
Symptoms like paresthesias (numbness and tingling), ulceration, severe pain, or persistent rashes lead major insurance companies, including Aetna, Cigna, and United Healthcare, to classify breast reduction as a cosmetic procedure, unless it satisfies the requirements that make it a medical necessity. Most insurance providers provide complete or partial coverage for breast reduction surgery as long as it fulfills those requirements.
In order for the insurance carrier to provide coverage, they may classify the procedure as reconstructive instead of cosmetic, if you can demonstrate its medical necessity. You must also show that you have made efforts to address these issues using alternative methods like medication or physical therapy, for the insurance carrier to approve the procedure.
How Much Does a Breast Reduction Cost?
According to the American Society of Plastic Surgeons, the estimated price for reduction mammaplasty in 2020 is around $5,900. This cost covers the fee charged by a certified plastic surgeon, as well as hospital fees, medical and diagnostic tests, surgical and post-surgical clothing, and prescribed medications. However, the cost of anesthesia is not part of this package.
To proceed with the surgery, you have the option to acquire approval from your insurance provider, enabling your surgeon to provide you with an estimate for the ultimate expense of the procedure. The surgeon’s fee is influenced by factors such as the practice’s location, the surgical methods employed, and the level of skill and proficiency they possess.
How Do You Get Insurance to Cover Breast Reduction Surgery?
There are multiple procedures you must follow to obtain insurance coverage for breast reduction surgery, which include:
Pre-authorization
If you have comprehensive insurance coverage that includes breast reduction, it is necessary for you to provide documentation to prove that you need medically necessary pre-authorization.
You may need to provide these documents dating back from 6 to 12 months. Before scheduling your surgery, you will need to provide medical records from licensed physicians demonstrating attempted conservative interventions and physical complaints experienced by you.
Some of the healthcare professionals you might need to obtain notes from include your obstetrician/gynecologist, primary care physician, orthopedic specialist, or physical therapist. Additionally, most plastic surgeons suggest that you provide documentation of any complementary alternative medicine (CAM) treatments, such as acupuncture or chiropractic care.
During your initial breast reduction consultation, your doctor may also take photographs of your pre-operative breasts as evidence for the insurance company. Additionally, they can provide you with a note documenting the symptoms that lead you to seek a breast reduction.
In your case, breast reduction surgery is deemed medically necessary if the documentation is assessed by a group of medical experts employed by the insurance company to evaluate your medical history.
Initial rejection
According to the AARP, all insurance claims, up to 14%, are initially denied. This means that you cannot get coverage for your breast reduction surgery. However, you can appeal the rejection. You should write a letter to your insurance board explaining why you are a suitable candidate for the surgery. Additionally, you can obtain support letters from other medical professionals to help your case.
Authorization
Your documentation has been approved, and once your insurance company authorizes it, you can schedule your breast reduction surgery. Typically, you will be responsible for a co-payment for your hospital or medical facility stay, which can range from $100 to $300, as required by most insurance companies.
Visit A Fitting Experience Mastectomy Shoppe for Post Surgical Garments
If you require garments for chest support after undergoing breast reduction surgery, our range of vests and compression bras at Shoppe Mastectomy Experience Fitting is worth exploring.
You can begin the process of claiming your insurance provider’s assistance by directly billing your bills. Additionally, our staff can help you navigate through the paperwork by utilizing our secure online portal that complies with HIPAA regulations.