What are insurance companies looking for to cover breast reduction surgery? only serious responses please.?

i've talked to my PCP and a surgeons office and have not gotten much info from them. i was told that insurance companies want to see that the surgery is "medically necessary" but what do they want to see to prove that? what do they want documented? i was asked if i had xrays done-but xrays of what?? what are they trying to see? any info would be appreciated. thanks.

It depends.

Sounds like your insurance company is going to be a PITA.

Some want you to lose weight, some want you to have it documented about your back pain, some want you to see a chiropractor for a few months.

http://www.breasthealthonline.com

Check out that site for assistance with your PS. They are VERY helpful!

Medically necessary would mean that you would suffer significant health problems without the treatment. You have to remember that insurance companies are in it for the money, so for them, if it will result in less doctor visits then they'll likely approve. So for example, if the weight is significant enough to cause you serious long term back and posture problems and it can be medically shown, then you are more likely to get approval.

The x-rays are probably checking for spinal abnormalities that could possibly be attributed to the awkward weight distribution caused by large breasts.

They probably want to see if you've had back and/or neck pain and they're looking for a paper trail.

I had the surgery done last year and it was covered by my insurance company at 90% after my deductible. I had a LONG history of back and neck pain (my neck was so bad it would swell up and I couldn't move it) that caused severe headaches, I could not stand upright without major pain, had indentations from my bra straps, had seen a chiropractor in the past, and had a great doctor that wrote to the insurance company on my behalf. I also have a muscle condition, and the extra pain only added on to the problem. Also, they need to be able to remove over a certain amount of breast tissue before the insurance company will even consider it. Talk to your doctor and ask why they need these things and what they are for. Any good doctor will be able to give you a straight answer. If they can't, then find another one in your network. You need to be comfortable with your surgeon.

Good luck to you! It was one of the best things I ever did!

I suggestion with you to call your health insurance provider to find out what is cover for breast reduction. Some insurance company will not cover for it.

Sweetheart, the insurance companies define what
"medically necessary" is. So call yours.

There are other options. For example, MySimpleCard
will help you regardless of whether your breast
reduction operation is "medically necessary" or
"cosmetic". They require no paperwork.

Breast reduction surgery is very safe nowadays. My cousin got her breast reduction, tummy tuck and facelift surgery in India by the company called Tour2india4health Consultants .The Price for the surgery she paid in India was very less. She paid 30% of the cost she was quoted in America.

Tour2india4health Consultants is very famous in India. They arrange cosmetic and plastic surgery for foreigners in India. I read a lot about them in the Newspapers and about their patient stories. They arrange financing for USA, Canadian, UK and other international patients who plan to have surgery abroad for low price, as the breast reduction, tummy tuck, facelift and other cosmetic surgery is not covered by insurance. They also have photos pasted of their International patients. You can checkout their website. There are huge cost savings. As a doctor I personally believe that surgery can be easily handled in India, as the quality of healthcare available In India is simply best in the world. The surgeons are USA/UK trained and facilities are 5 star.

http://www.tour2india4health.com
Hope this helps.