How To Get Health Insurance To Pay For Breast Reduction

How to Get Your Breast Reduction Covered By Insurance RealSelf News from www.realself.com

Breast reduction is a surgical procedure that reduces the size and weight of a woman's breasts. While it is often performed for cosmetic reasons, some women require breast reduction surgery to alleviate physical symptoms, such as back and neck pain. However, the cost of breast reduction surgery can be prohibitive, and many women are left wondering if their health insurance will cover the procedure. In this article, we will explore how to get health insurance to pay for breast reduction surgery.

Understanding the Criteria for Breast Reduction Coverage

The first step in getting health insurance to pay for breast reduction surgery is to understand the criteria for coverage. Most insurance companies require that the surgery be medically necessary, which means that it must be performed to alleviate physical symptoms. In addition, insurance companies may require that the patient has tried other treatments, such as physical therapy or pain medication, before approving surgery. Finally, insurance companies may require that a minimum amount of breast tissue be removed during the procedure.

Documenting Medical Necessity

To document medical necessity, patients will need to provide their insurance company with a letter from their doctor explaining the physical symptoms that they are experiencing and how breast reduction surgery will alleviate those symptoms. In addition, patients may need to provide documentation of other treatments that they have tried and failed, such as physical therapy or pain medication. Finally, patients may need to provide documentation of their breast size, such as measurements or photographs, to demonstrate that a minimum amount of breast tissue will be removed during the procedure.

Working with Your Insurance Company

Once you have documentation of medical necessity, you will need to work with your insurance company to get approval for the procedure. Start by contacting your insurance company to find out their specific requirements for breast reduction coverage. Then, provide them with all of the necessary documentation, including the letter from your doctor and any supporting documentation of other treatments that you have tried. Be prepared to answer any questions that your insurance company may have, and be persistent in following up with them until you receive a decision.

Other Ways to Get Breast Reduction Coverage

If your insurance company denies coverage for breast reduction surgery, there are other options that you can explore. Some states require insurance companies to cover breast reduction surgery if it is medically necessary, regardless of the insurance company's specific requirements. In addition, some employers offer health plans that cover breast reduction surgery, so be sure to check with your HR department to see if this is an option for you. Finally, if you are unable to get coverage through your insurance or employer, you may be able to finance the procedure through a medical financing company.

Conclusion

Breast reduction surgery can be a life-changing procedure for women who are suffering from physical symptoms due to the size and weight of their breasts. However, the cost of the procedure can be a barrier for many women. By understanding the criteria for coverage, documenting medical necessity, and working with your insurance company, you can increase your chances of getting health insurance to pay for breast reduction surgery. If you are unable to get coverage through your insurance or employer, there are other options that you can explore to make the procedure more affordable. | Criteria for Coverage | Documentation Needed | Other Options for Coverage | | --- | --- | --- | | Medically necessary | Letter from doctor explaining physical symptoms and how surgery will alleviate them; documentation of other treatments tried and failed; documentation of breast size | Some states require coverage for medically necessary breast reduction surgery; some employers offer health plans that cover the procedure; medical financing companies may offer financing options |

Source: www.realself.com