How to get insurance to pay for breast reduction bcbs?

how to get insurance to pay for breast reduction bcbs
Both of the following requirements must be satisfied: The patient’s breasts have reached maturity (ie, breast size stable for approximately one year) 2. The quantity of tissue to be removed from each breast must exceed or equal the 22nd percentile on the Schnur Scale.

Will insurance cover breast reduction surgery?

What effect does preapproval have on the procedure? – If your breast reduction is approved, your insurance company will cover the cost of your surgery as long as you adhere to the pre-approved plan: you must have the required number of grams of tissue removed from each breast by an in-network physician at a facility that participates in the plan you’re covered by.

In general, “all treatments covered by insurance are conducted in hospitals,” Dr. Nwubah explains. As evidence that adequate tissue is taken, doctors weigh the resected tissue from each breast and record the grams per side in the operation report if the private operating room is certified with insurance.

In general, plastic surgeons consider insurance requirements for funding a breast reduction to be obsolete, unjustified, and restrictive. However, if you select a surgeon whose staff has perfected the preauthorization procedure, you have a decent chance of having the treatment covered.

Surgical breast reduction is sometimes referred to as reduction mammoplasty. It includes the removal of breast tissue, and some private insurance include it as a covered benefit under specific conditions. The qualifying requirements for Blue Cross Blue Shield breast reduction are detailed below.

How can I obtain pre-approval for a breast reduction?

How Do I Obtain Breast Reduction Insurance Coverage? – To obtain pre-approval for breast reduction surgery so that your insurance company would cover the costs, you must accomplish two key objectives: You must first have a valid reason for why breast reduction surgery is important for you.

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In other words, it should have a medical background so that the corporation may write it off as a severe medical condition that poses a threat to your wellbeing. Therefore, the term cosmetic surgery, which is commonly applied to breast reduction surgery, should be changed to medical reconstructive surgery.

The insurance is searching for evidence that this “medical requirement” is interfering with your life in some manner, such as back discomfort, neck pain, etc., which are the most typical complaints women with large breasts complain about. You should also demonstrate to the insurance that you have tried other conservative therapy that have been unsuccessful.

  • This indicates that the other choices you tried as potential solutions for your problem did not work, thus you must have breast reduction surgery to resolve the issue.
  • Conservative treatments include chiropractic care for back and neck problems and physical therapy for discomfort.
  • In addition, it involves the use of support and bras designed to assist with breast weight.

Examine your current health insurance coverage to determine whether it covers cosmetic operations. If you’re fortunate, you may discover that certain insurance companies give assistance for these issues and cover the associated expenditures. Learn your insurance claim rights so that you are constantly at the top of your game.

What is reduced breast reduction?

What Constitutes Breast Reduction? Reduction mammaplasty or breast reduction surgery is a common operation for women desiring to lower the size of their breasts. This operation is performed for both aesthetic and medical reasons. Many physical symptoms accompany breast enlargement, which might cause some women anxiety.