Trying to get coverage for breast reduction surgery can be very challenging. Health insurance companies have lots of different guidelines that patients have to meet. It is important to know what coverage your particular insurance has as some policies have an exclusion for breast reduction surgery altogether.
If your policy does not exclude reduction mammoplasty surgery some of the requirements you might have to meet may be:
• a minimum of breast tissue to be removed
• a report from a physical therapist for treatment
• a letter from your doctor describing symptoms and attempted treatments, such as prescribed analgesics
• Use of special bras
Even when all of the above criteria have been met, some insurance companies will still deny surgery. Possibly they are hoping you will give up. At this point Dr. Delgado requests an appeal. He has been very successful in getting an approval with this approach. Most insurance companies respond to an appeal by having a medical doctor call your surgeon to discuss the case. This is when it is imperative that your surgeon understand the ins and outs of the insurance companies and how to present your case.
If you discover that your breast reduction surgery has been denied because it is not a covered procedure under your policy, none of the above conditions will make a difference. A solution might be to consider changing your insurance coverage during an open enrollment period. If you have your insurance through your employment perhaps your Human Resources representative can help you find a better policy.
Having insurance cover breast reduction surgery for men is even more frustrating. Insurance companies do not cover cosmetic surgery and there needs to be a lot of evidence that surgery is a medical necessity. Gynecomastia can be psychologically devastating for men, but unless there is physical pain involved, applying for coverage can be a fruitless endeavor.
Dr. Delgado has had many years of experience in helping patients obtain medical insurance coverage for breast reduction surgery. After an evaluation by Dr. Delgado, he will be able to tell you how likely it will be for you to get approval, and if you hit roadblocks he will be there to support you!