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Size K breasts need to be reduced

Q:

I have size K breasts. I weigh 170 lbs and am 5'3". Even losing weight I generally only go down 1-2 cups. I would love to have them reduced but my insurance company outlines a path of physical therapy, massage, chiropractic consultation , and weight loss prior to their approval of the procedure. I was wondering which order I should attack this? Also, how do I find doctors/providers who are more likely to push with the insurance company? The provider is Premera. I am losing excess weight.

A:

 Insurance Carriers dictate Health Care today not physicians since, they are paying for the services you receive. Insurance plans are like cars. Some are Dodge Metro’s designed just to get you from A to B while others are Fords. The Cadillac plans are becoming very rare. If you have an inexpensive plan Breast Reductions may not be easily covered or not covered at all. 

 May I suggest you first consider upgrading or changing your insurance plan for better coverage. If this is not possible then, pursue your insurance carriers requirements for you to have a breast reduction through your primary care physician or Gynecologist. Complete all their requests and if you are denied your surgery request why. Be aware that some insurance plans make their clients jump through some incredible hoops to even be considered for a Breast Reductions to be covered. While other plans are less restrictive. Again, it is often related to the expense of the plan. 

 Asking your surgeon to “Push” an insurance carrier is not a wise move. This is your insurance plan and you are the best advocate. Surgeons are merely service providers that can easily be replaced in todays Health Care Marketplace. A better option may be to consider having your Breast Reduction done as a Cosmetic procedure. Your overall out of pocket expenses could be less depending upon your co-pay’s, deductibles, non covered sevices, etc.? Hope this is of assistance. Best,

 

Gary R Culbertson, MD, FACS

A:

You are correct that breast reduction will likely help you in many ways, and your plastic surgeon is in an excellent position to perform the surgery and post op care.  The surgeon is not very capable of making your insurance company change their restrictions.  The plan restrictions are a product of contract negotiations between your employer and the insurance company.  They frustrate reconstructive surgeons on a daily basis.

You should contact the insurance company for their recommendation about the proposed path to meet their requirements.  If you eventually find that the requirements are unrealistic for you, you may consider affordable care through your plastic surgeon, outside of the insurance plan.  In many cases surgery, anesthesia, facility fees, lab work, etc. can be purchased as a package well below hospital / insurance prices, if your have to pay out-of-pocket.  Best wishes.

A:

If those big breasts are causing you pain and an emotional disorder, you can visit an orthopedic surgeon and a Psychiatric that can report those problems to your insurance company, with a recommendation of a breast reduction. Then try to choose an ASAPS plastic surgeon in your area.

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