There is a high likelihood you may qualify for insurance-covered breast reduction surgery.
Most insurance companies require patients to go through an extensive qualification procedure before approving breast reduction surgery. Unfortunately, this process can sometimes take years. Even worse, many patients experience years of extreme discomfort and severe side effects and are still not able to get approval for coverage. This guide was created to provide you with the most comprehensive set of guidelines and recommendations so that together, we can help change this trend and get women who need this surgery the coverage they deserve.
Why are so many women told that their insurance won't cover their breast reduction surgery?
The process of pre-qualification for insurance-covered breast reduction surgery is extensive, and differs by insurance company. Further, it requires a diligent and specifically documented medical record over the course of time by your PCP (primary care physician) or Ob/Gyn. The problem is, most insurance companies do not make the documentation and qualification requirements easily accessible to PCP's and Ob/Gyn's. Thus, when they (or a reconstructive surgeon) calls your insurance company to get a pre-authorization for breast reduction surgery (meaning they call to see if your insurance will cover it), it is declined. So your doctor is telling you the truth that your insurance company declined your surgery, but they aren't ever told that there is a way to get it approved. After extensive experience working with insurance companies, we have developed this guide for patients so that they have clarity in what they need to do in order to qualify and what steps they need to take. We then have developed a guide for you to bring with you to your PCP or Ob/Gyn that provides them specific details on what the insurance companies require of them as you go through this process.
Guide for your PCP and/or Ob/Gyn
on documentation requirements and guidelines for insurance-covered breast reduction surgery