Whether one qualifies for medical insurance coverage is not a mystery as most insurance companies have very specific criteria to qualify for eligibility. In fact, it is one of the most scrutinized of all plastic surgery procedures covered by insurance. There are several important issues including your weight and breast size, how much tissue the plastic surgeon plans to remove, documentation of painful symptoms, and what other non-surgical treatments have you had.
Your body weight is an important consideration. Your health insurance carrier may require you to lose weight (or make a valiant effort) if you are 20% or more over your ideal body weight. We all know that weight loss will not decrease the size of your breasts (it some cases it may make the skin sag more, causing greater strain on your neck, shoulders, and back), nevertheless, this is a criteria that insurance companies use. At the least, if you are overweight, attempts at weight loss must be done and documented. If you can only lose so much weight, then so be it. But some weight loss effort may be required.
Breast size is an obvious important criteria. There is no precise breast size that makes the cut-off for insurance coverage. Rather it is a combination of your height, weight, and breast size. Technically, your height and weight are put into a formula to create your BSA. (body surface area) Based on your calculated BSA and the amount of breast tissue your plastic surgeon says will be removed (there is an industry standard graph and table which determines this) is the numerical determinant for medical eligibility. The amount of breast tissue your plastic surgeon says he will remove is an estimate but that submitted number is of critical importance. This numbers game, if you will, is really about the insurance provider being certain that the patient is not really getting a cosmetic breast lift as opposed to a real breast reduction. I call this compensation for the 'sins' of the past done by plastic surgeons from decades ago.
One of the hardest criteria to document, but is one of the big three, is what have you done non-surgically that may make your breast and body pain go away without surgery? We all know that nothing short of reducing large breasts will make their symptoms go away, but again, we must play by their rules. Some form of physical therapy, chiropractic treatment, or even acupuncture must usually be tried first (for three months) and documented that it did NOT work. This is the one criteria that many patients do not have when I see them in a breast reduction consult. It may feel like a waste of the insurance's money and your time, but it often must be done.
To determine possible medical coverage, your plastic surgeon will take photos and measurements of your breasts and bundle up all of the information listed above and send it to your insurance company. The more complete this information is, the less likely you will get a letter (4 to 6 weeks later) that says there is not enough information to make a predetermination. Your breast reduction may be determined to be medically necessary if you meet all the required criteria! It can be a slow process, and it may take more than one letter from your plastic surgeon, but persistence and perseverance is the key to a medical necessary breast reduction.
Breast Reduction Surgery Insurance
The truth is, you will be stunned to hear about awful back and neck pain, gouges in those women's shoulders that were made by bra, worsening posture with low readiness to be included in many crucial activities due to big breasts. When you hear that, it is very easy to comprehend why those women choose to have reduction mammaplasty procedure. For them, oversized breasts are a burden.
Reduction mammaplasty is taken when comes to breast hypertrophy. This usually happens in both breasts and starts at puberty or some time after puberty is over. Hear and there it occurs during pregnancy, not very likely, but enlargement does occur.
Cosmetic surgery can handle these conditions and solve the problem if the the woman is feeling unpleasant with her appearance and condition. In case a patient feels it's a solution to have breast reduction surgery, a cosmetic surgeon must acknowledge that decision and go for a process of deciding is the woman in question eligible for cosmetic operation.
Who Are Eligible Candidates?
Reduction mammaplasty is for women who have large breasts and want to resolve one or more issues they have:
1. constant back, neck and shoulder pain
2. Poor posture
3. Skin rash under the breasts
4. Deep grooves in the shoulders from bra strap pressure
5. Reduced levels of activity
6. Self-esteem problems
7. Difficulty fitting into certain bras
We also want to say that nearly half of all men today deal with gynecomastia, which means an enlargement of both breasts. Male breast enlargement can be caused by several different factors, for example anti-depressants, blood-pressure medicine, steroids and other factors. Breast enlargement may not be changed with diet and exercise. The breast reduction can be accomplished by liposuction.
Breast reduction surgery is very successful procedure and women are very happy with the results they receive. But, there are always some disadvantages of this cosmetic procedure. Most often are: bleeding, infection and an adverse reaction to the anesthesia. Besides those there are some other risks that are connected with breast reduction surgery:
1. Loss of sensation in breasts
2. Impaired blood supply to the breasts, leading to scarring
3. Losing the ability to breast-feed
4. Asymmetry in contour
5. Altered body image and a period of adjustment to the change in your appearance
Just before breast reduction operation itself, a cosmetic surgeon measures and puts marks on patient's breasts. This helps with planning and makes it easier for cosmetic surgeon to work. Reduction mammaplasty generally lasts 2-3 hours, while a patient is asleep. After the surgery, patient wakes up in a recovery room, and he is being monitored for any complications.
Concerning the costs of this surgery, they vary over a wide range, depending upon the cosmetic surgeon, operating region, the type of surgery and similar important factors. We want you to know it is not possible to give an accurate number so you have to contact a surgeon for that. The best thing is to check hospitals nearby and see what is out there. It's best to compare the terms, prices and similar conditions to see what what gives you most for your money.
After that you have to meet with a board certified plastic surgeon that can give you information that's specific to your plastic surgery. A detailed evaluation with cosmetic surgeon will help you to figure out what your options are and to think about realistic expectations about breast surgery results, risks, price and benefits.
Both Barry Eppley & Gillianran are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
Barry Eppley has sinced written about articles on various topics from Aging, Cosmetic Surgery and Health Insurance. Dr Barry Eppley, board-certified plastic surgeon of Indianapolis, is in private practice at Clarian Health in two suburban Indianapolis locations. He writes a daily blog on plastic surgery at. Barry Eppley's top article generates over 33100 views. to your Favourites.
Gillianran has sinced written about articles on various topics from Car Accidents, Interest and Food And Drink. Visit Gillians site to find out more about , what happens. Gillianran's top article generates over 135000 views. to your Favourites.
Change The Oil In Your Car Most swimming pool maintenance professionals have some type of guarantee on their service.With proper maintenance you can enjoy sparkling clean water all season long