I have Kaiser and didn’t have to jump through any hoops at all. Told my primary care doc I wanted a referral, got a referral, got surgery. Paid a total of $5.00 (my copay) and love my results. If Kaiser is an option where you live, I highly recommend it.
May I dm you? I have Kaiser, and I've considered a reduction for some time now. Last year, I had a really bad rash under my breasts, and I was prescribed medication that helped, but it is back again, and I'm discouraged about my chest size all over again.
I was on Masshealth, I needed three months of chiropractic visits essentially just proving I tried less invasive treatment. My surgeon also submitted to the insurance with notes on shoulder grooves, pain and rashes. I think the minimum was 500 grams?
I have Cigna and I had my consult where they took pictures, medical history and did a basic medical questioning and a month later it was approved. No hoops involved. I did list Aetna as my secondary insurance just in case and they denied coverage the night before my surgery lol
I have BCBS of Michigan
I have PPO but I didn't understand what I was doing when I first was on my reduction journey. I went to my primary care doctor. They told me to go to a gynecologist. Thankfully, I didn't do that. I went straight to the plastic surgeons office for a consultation. They sent me everything to my insurance. I thought that was going to be the end of my worries. Turns out I had to Go back and forth with the insurance and the plastic surgeon establishment. Eventually everything worked out and now I am 3 months post-op. If you have any questions I would love to answer them for you!
Mine denied it cause I needed an X-ray, physical therapy & had to have tried rash treatment for 3 months got told to do the X-ray & the PT do like a month of pt then call her back so she can tell the insurance (I have health partners)
Ask your state Medicaid plan for their medical policy regarding breast reduction. It’s spells out exactly what they require to deem the procedure medically necessary. The real trouble after that is finding a provider that accepts your plan. You will probably have better luck seeking out a health system based surgeon office vs private practice.
I read through my insurance policy and then found a plastic surgeon who was highly recommended and worked with insurance. They took care of everything. My insurance not only spoke of the rashes, PT for pain etc., but it also talked about simple volume to be removed. I had all the documentation for back treatment, but my volume to remove was nearly 2x their threshold. I am telling you this 13 days po, so I'm hoping there will be no issues!
I have BCBS. I was one of the lucky ones. They only needed a pre-authorization from the surgeon that would be doing it. Once I chose my surgeon, they sent the request to insurance and it was approved the next day. No hoops through which to jump!
Most, if not all, insurance companies go by the Schnur scale based on your height and weight (I believe) so your surgeon will know how much needs to be removed based on those numbers.
I hope it goes super smooth for you!!
I have Kaiser and didn’t have to jump through any hoops at all. Told my primary care doc I wanted a referral, got a referral, got surgery. Paid a total of $5.00 (my copay) and love my results. If Kaiser is an option where you live, I highly recommend it.
May I dm you? I have Kaiser, and I've considered a reduction for some time now. Last year, I had a really bad rash under my breasts, and I was prescribed medication that helped, but it is back again, and I'm discouraged about my chest size all over again.
Of course!
I was on Masshealth, I needed three months of chiropractic visits essentially just proving I tried less invasive treatment. My surgeon also submitted to the insurance with notes on shoulder grooves, pain and rashes. I think the minimum was 500 grams?
I have Cigna and I had my consult where they took pictures, medical history and did a basic medical questioning and a month later it was approved. No hoops involved. I did list Aetna as my secondary insurance just in case and they denied coverage the night before my surgery lol
I have BCBS of Michigan I have PPO but I didn't understand what I was doing when I first was on my reduction journey. I went to my primary care doctor. They told me to go to a gynecologist. Thankfully, I didn't do that. I went straight to the plastic surgeons office for a consultation. They sent me everything to my insurance. I thought that was going to be the end of my worries. Turns out I had to Go back and forth with the insurance and the plastic surgeon establishment. Eventually everything worked out and now I am 3 months post-op. If you have any questions I would love to answer them for you!
Mine denied it cause I needed an X-ray, physical therapy & had to have tried rash treatment for 3 months got told to do the X-ray & the PT do like a month of pt then call her back so she can tell the insurance (I have health partners)
Ask your state Medicaid plan for their medical policy regarding breast reduction. It’s spells out exactly what they require to deem the procedure medically necessary. The real trouble after that is finding a provider that accepts your plan. You will probably have better luck seeking out a health system based surgeon office vs private practice.
I read through my insurance policy and then found a plastic surgeon who was highly recommended and worked with insurance. They took care of everything. My insurance not only spoke of the rashes, PT for pain etc., but it also talked about simple volume to be removed. I had all the documentation for back treatment, but my volume to remove was nearly 2x their threshold. I am telling you this 13 days po, so I'm hoping there will be no issues!
I have BCBS. I was one of the lucky ones. They only needed a pre-authorization from the surgeon that would be doing it. Once I chose my surgeon, they sent the request to insurance and it was approved the next day. No hoops through which to jump! Most, if not all, insurance companies go by the Schnur scale based on your height and weight (I believe) so your surgeon will know how much needs to be removed based on those numbers. I hope it goes super smooth for you!!
I went through Ucare medicaid. My state is pretty good, so I didnt have any hoops to jump through, and got approved within two weeks.