How Long Does It Take To Get A Breast Reduction Approved By Insurance

How Long Does It Take To Get A Breast Reduction Approved By Insurance

Breast reduction is an elective procedure. Breast reduction on average costs $7,500 to 8,500 per procedure. However, when including the cost of anesthesia, breast implants and hospital fees, it can easily reach $15,000 cost for surgery alone, Stretch marks. Ugly scars. Excess skin. Maybe even sagging breasts that don’t seem to go away, even though you’ve lost most of your pregnancy weight (a likely culprit: breastfeeding). If you’re thinking about breast reduction surgery, you may be wondering if it will be covered by insurance.

We’ll go over some of the factors that could influence how long it takes for your breast reduction surgery to be approved by your insurance company. read more about Breast Reduction Requirements Weight/When Is A Breast Lift Medically Necessary.

How Long Does It Take To Get A Breast Reduction Approved By Insurance

You’re looking for a way to get insurance to pay for breast reduction surgery. You’ve probably heard about how difficult it can be, but you’re determined to find a way.

Luckily, there are things you can do to make the process easier—and we’re here to help with that!

The first thing you should do is evaluate your insurance coverage. Some policies cover breast reduction surgery, while others don’t. If your policy does cover it, then you’ll just need to contact your insurance company and ask them what they need from you before they can approve your claim.

If none of those options sound appealing either (and believe us—they should!), then check out this article from [company name]. It goes over everything from why having large breasts can be uncomfortable or painful (even if they don’t seem like such a

Getting insurance to pay for a breast reduction can be a complicated process. You’ll want to start by finding out what your carrier’s policy is on plastic surgery, as well as which procedures they cover and which ones they consider cosmetic. Your doctor should be able to help you with this.

If your insurance does not cover the procedure, talk to your doctor about alternative financing options. Many surgeons offer financing directly through their office, so it’s worth asking about this option before you sign up for any related procedures.

Breast reduction surgery is done using general anesthesia and requires an overnight stay at the hospital. It takes between two and three hours to perform the operation, which involves removing fat, skin, and tissue from the breast area before closing up the incisions with stitches or staples. Afterward, patients may need further treatment depending on their individual needs such as physical therapy or massage therapy sessions in order to speed up recovery times while reducing swelling and bruising around those areas where excess skin had been removed during surgery (i.e., underarm area).

If you have been diagnosed with large breasts, you may be able to get insurance coverage for breast reduction surgery. However, there are several factors that must be taken into account before your insurance company will cover breast reduction surgery.

How Is Breast Reduction Surgery Covered?

Some insurance plans will only cover certain types of breast reductions, such as reductions done for medical reasons such as back pain or neck pain rather than purely cosmetic reasons like wanting smaller breasts because they feel they are too big or heavy on the chest area where they sit all day long while working at a desk job

Breast Reduction Requirements Weight

The beast candidate for breast reduction has fully developed breasts. Your weight should be stable. If you plan on losing weight it is better to do so before surgery. Your BMI is 35 (based on your height and weight) it is considered best practice to operate on a patient that has a BMI of less than 30.

Also known as reduction mammaplasty, breast reduction surgery aims to decrease the size of female breasts to meet cosmetic or physical goals. For a significant number of women, having excessively large breasts can cause all sorts of problems, from back and neck pain to shoulder grooving and rashes. In 2017, there were 43,635 aesthetic breast reduction patients in the US alone, an 11 percent increase from the previous year. Many more received this procedure as a corrective treatment for symptomatic macromastia (large breasts). These numbers demonstrate the increasing prevalence of breast reduction surgery.

If you’re thinking about undergoing a breast reduction surgery, this article explores the issue of insurance coverage and required qualifications.

IS BREAST REDUCTION COVERED BY HEALTH INSURANCE?

Breast reduction is considered to be a cosmetic procedure (which is not usually covered by insurance) until the patient can demonstrate a number of associated health issues and attempted treatments. Male and female patients who are seeking breast reduction must show that they have tried other medical treatments and sought prior consultations regarding macromastia before settling on surgery. This may include showing a history of referrals for chiropractic treatment or physical therapy focused on elevating the physical symptoms of excessively large breasts.

For breast reduction to be covered by insurers, a lack of documented history by the patient could prove to be an issue.

INSURER CRITERIA FOR COVERAGE OF BREAST REDUCTION SURGERY

Insurers typically rely on a number of things to establish whether your reduction surgery qualifies for coverage.

1. Medically indicated signs and symptoms – insurers rely on special references of medical problems under the International Classification of Diseases (ICD) codes. Some of the physical symptoms that may be recognized by insurance companies in relation to excessively large breasts include postural backaches, upper back pain, neck pain, skin irritations (intertrigo), and pressure causing numbness.
2. Body mass index – the BMI is a special system that compares the weight and height to establish an individual’s weight status. Some companies may refuse to pay the bill for breast reduction surgery unless the patient’s BMI is less than 30. Others will only accept BMI that is less than 35, while some companies require documented proof that the patient has tried to lose weight either through exercise, diet, or weight loss surgery.
3. The weight of tissue to be removed – insurance companies will also rely on the amount of tissue to be removed from each breast to determine whether or not the reduction patient qualifies for coverage. Depending on the company, this weight requirement may be 450 grams, 500, or even 600 grams. Some insurers leverage a much more detailed approach to ensure they do not penalize patients with a smaller stature but disproportionately large breasts. 90 percent of times when the patient meets these weight requirements, coverage is provided. Women who have DD, DDD and H cups typically qualify.
4. Matching reduction after breast cancer – coverage is provided in cases where the patient needs to have reduction surgery to balance a larger, healthy breast with one that was affected by cancer treatment. This is provided for by the 1998 Women’s Health and Cancer Rights Act. The legislation covers reconstructive treatment on a breast affected by cancer, as well as balancing procedures for the healthy breast to match the reconstructed one.
5. Evidence from other physicians – before you even get to your breast reduction in Scottsdale AZ from a surgeon, your insurer may require that you provide supportive letters from other physicians requesting breast reduction to treat macromastia symptoms. Letters documenting alternative remedies such as physical therapy, weight loss, and exercising in an attempt to correct the situation will also suffice.
6. Photographs and measurements – your breast reduction surgeons may need to provide de-identified photos (from the neck down) and specific measurements quantifying your breast size in relation to your frame.

If you feel like you may be a good candidate for breast reduction coverage, get in touch with your insurance carrier and ask them to forward (in writing) the criteria for coverage. Different insurance companies have different indications and criteria. Also, keep in mind that it takes about 3-6 months (on average) of preparations before you can seek the insurer’s intervention. This preparation entails consultations with other practitioners for alternative remedies such as chiropractic or physical therapy.

Breast reduction surgery can help women who are unhappy with the shape, weight or droop of their breasts by making them smaller and more lifted.

But if it’s done to improve appearance rather than for health reasons, it’s not normally available on the NHS. Instead, you’ll need to pay for the procedure privately.

Information about breast reduction for cosmetic reasons is provided elsewhere.

Read about cosmetic breast reduction for women and male breast reduction.

This page focuses on when breast reduction might be available on the NHS.

Eligibility criteria for NHS breast reduction

The availability of breast reduction surgery on the NHS varies, depending on the eligibility criteria decided by your local integrated care board (ICB).

Some ICBs do not fund breast reduction surgery at all, and others fund it selectively if you fulfil certain criteria.

Generally speaking, you might be considered for breast reduction on the NHS if you have problems caused by having very large breasts, such as:

• backache
• shoulder or neck pain
• skin irritation
• rashes and skin infections under the breasts
• grooves on the shoulders from bra straps
• psychological distress, such as low self-esteem or depreKssion
• an inability to exercise or take part in sports

ICBs also tend to have additional criteria that may include the size of your breasts, your weight, your age, whether you smoke, and whether other options (such as wearing professionally fitted bras) have been tried, but have not helped.

You can find out what the eligibility criteria are in your area from a GP or by contacting your local ICB.

The referral process

See a GP if you think you might be eligible for breast reduction surgery on the NHS.

They can check whether you meet the criteria of your local ICB and, if you do, they can refer you to a breast or plastic surgeon for an assessment.

This may involve:

• asking about the problems you’re having
• checking your weight and general health
• an assessment by a psychiatrist or psychologist
• information about the risks and results of surgery

The assessment will help determine whether you’re suitable for surgery and whether there’s a strong enough reason for this to be done on the NHS.

The final decision is usually made by a panel of representatives from your local ICB, which will take into account the information from your assessments and a review of your individual case.

Things to consider before you go ahead

It’s important to discuss your problems and options with a GP and an appropriately qualified surgeon before having a breast reduction.

This will help you get a clear idea of what changes you can expect to see and ensure you’re aware of any risks involved.

Be aware that:

• a significant reduction can alter the shape and look of your breasts
• there will be scarring and possibly lost or altered nipple sensation
• your breasts can change in size and shape after surgery – for example, they may increase or decrease in size if you put on or lose weight
• breasts have a tendency to droop over time
• your breasts can get bigger during pregnancy and you may not be able to breastfeed after surgery – so you may need to wait until you’re sure you do not want to have any more children

For women with very large breasts, the benefits of a reduction may outweigh any potential problems.

But for women with only moderately large breasts, the benefits may not be worth the risks.

Alternatives to breast reduction surgery

It’s sometimes possible to reduce problems caused by having large breasts without the need for surgery.

The following measures may help:

• if you’re overweight, losing weight can sometimes help reduce the amount of fatty tissue in your breasts
• a professional bra-fitting service – for many women with problems caused by large breasts, getting a professional to fit a correctly sized bra can reduce discomfort
• physiotherapy – exercises from a physiotherapist can sometimes help with aches and pains caused by large breasts
• psychological support and treatment – this can help if your large breasts are causing emotional or mental health issues

Breast reduction surgery will usually only be available on the NHS if you have first tried alternative measures.

Male breast reduction on the NHS

Male breast reduction is not normally available on the NHS.

This is because enlarged breasts in men (gynaecomastia) are usually a result of being overweight, and losing weight will often help to reduce their size.

You’ll normally need to pay privately for breast reduction surgery in these cases.

But breast reduction on the NHS may sometimes be considered if it’s caused by an underlying condition, or if losing weight has not helped.

When Is A Breast Lift Medically Necessary

If your breasts are causing any medical problems such as pain, skin chafing, irritation and infections and the breast lift is considered to be the only way to reverse these issues, it will be deemed as a medical necessity.

The Pencil Test 

While the pencil test doesn’t hold merit in the doctor’s office, this quick at-home activity can give you an idea of your degree of breast ptosis (drooping). Lift one breast, place a pencil in the crease underneath and then release the breast tissue. If there is enough sagging tissue to hold the pencil in place, you may be a good candidate for breast lift. Pay attention to the direction and location of the nipple in relation to the pencil, as this can indicate the severity of breast drooping. 

Nipple Position and Placement 

The ideal breast shape has nipples that point outward and sit above the breast crease (inframammary fold) with minimal breast tissue extending past the fold. Breast ptosis is split into grades, including: 

The breast tissue under the nipple may also droop lower than the fold, causing pseudoptosis. 

Surgical Approaches to Breast Lift 

The severity of breast ptosis dictates the surgical technique, and the varying stages require a customized approach. Dr. Donald Hause may use one of these breast lift (mastopexy) options: 

• Binelli (Doughnut) Mastopexy: Best for mild breast drooping, the doughnut breast lift involves two circular incisions in the areolas. The tissue in the inner portion of the “doughnut” is removed, and the skin is pulled together like the strings of a purse. Breast augmentation combined with breast lift often uses the Binelli approach. 
• Lejour Limited Scar Breast Lift: Dr. Hause molds and reshapes the breast tissue into a new cone suspended higher on the chest wall held in place with internal sutures. The Lejour mastopexy uses the two circular incisions from the doughnut lift and adds another that extends to the breast fold. This technique may lead to more natural-looking and longer-lasting results. 
• Vertical Mastopexy: The vertical breast lift offers the best access to breast tissue and is used to correct severe breast ptosis and improve breast shape with an implant. The anchor incision uses two circles around the areola, a line to the breast crease and another along the fold, forming an anchor shape. Vertical mastopexy can achieve the most significant improvement in chest position and breast shape. 

If you are plagued with large breasts that are causing major problems, breast reduction surgery can prove very beneficial to your well-being. There are many factors involved for a reduction to be medically necessary, and you will need to meet with a breast reduction surgeon for a consultation to determine your eligibility.

Why is breast reduction done?

Breast reduction is a cosmetic surgery that changes the size, weight and shape of the breasts by removing excess tissue and fat deposits. For many women, having big breasts is a burden because they cause back and neck pain, posture issues and skin irritation. Furthermore, the pull of bra straps on the shoulders can create indentations. Large breasts can also limit the physical activities you can do because you cannot find a sports bra or exercise clothes made to support your ample chest. In some cases, even with the right support garments you may find physical activities painful due to your chest size. Finally, large breasts can cause unwanted attention and appear disproportionate in relation to your weight and height.

What criteria is needed for your breast reduction to be medically necessary?

In Canada, most medical breast reductions are covered, but the government has certain criteria in place that a woman must meet in order for her reduction to be deemed a medical necessity:

• Back, neck and shoulder pain
• Bad posture caused by the weight of the breasts
• Rashes under the breasts in the area where the bra meets skin
• Indentations/grooves in the shoulders from the bra strap
• Inability to do any physical activities comfortably