Breast reduction is one of the operations that my patients are the most happy with afterward because of their almost immediate relief from upper neck and back pain. Most patients tell me the day after surgery that they can already tell they feel better. This is one of the best aspects of this operation, but there are many others, such as clothes and bras fitting better, exercise being easier, and the post-op journey being almost pain-free.
At Aesthetica Surgery and Spa, we are committed to improving our patient’s quality of life with this operation. In most cases, the insurance carrier will cover the majority of the cost for this surgery, but the process of achieving pre-operative approval is not that straightforward.
This blog will cover the breast reduction insurance approval process and help patients considering this life-changing operation better understand and navigate this journey.
WARNING:
This feature contains nudity. Please click OK to confirm you are at least 18 years of age and are not offended by such material.
Breast Reduction Is a Covered Benefit
This is the language or statement that many insurance companies have on their websites or will say to you if you call them. And it is true, BUT …. there is a big “BUT.” This is the fact that the patient must meet the criteria of their insurance company, and then and only then, it is a covered benefit. It gets even more complicated because the criteria are different for each insurance company. The other big “but” is that you must get this approval ahead of time. But do not worry (this time a good “but”); at Aesthetica Surgery & Spa, we will help you!
How To Qualify for Breast Reduction Through Insurance
Step 1: Call Us
The process can take a few weeks or even months, so the first step is to call us! We deal with this every day and know what to do. To be sure you have breasts that are large enough to be considered, you will send us a quick selfie. Then, we will send you a checklist of items that you will gather to prove medical necessity for your surgery.
These items include documentation from your primary care physician that you have been complaining about neck and back pain for some time, usually about a year. This medical documentation can also include other problems you have related to the very large size of your breasts, including rashes and skin breakdown underneath them and deep shoulder grooves from your bra straps.
Other helpful reports are any chiropractic visits you have had for your neck and back pain. For patients over 40, we will need you to gather a copy of your last mammogram report. When you have all these papers, you will bring them to the office to meet with our insurance specialist. She will check to be sure we have the correct documentation and also get a copy of your insurance card since the next step is your consultation in the office with me.
Step 2: In-Person Consultation at the Office
Once you have gathered the items on the checklist and have been cleared by the insurance specialist, you will have your consultation with me. At this visit, I will do a physical exam of your breasts, taking measurements to quantify and document your situation. This is also when we take pictures to submit to your insurance company, along with the other documentation.
During our time together, you will watch an educational video for about 10 minutes and then have 40 to 50 minutes with me to go over the Informed Consent paperwork and recovery questions such as recommended time off and exercise restrictions.
At this visit, we discuss your goal bra cup size and how much your particular insurance company requires for removal. This visit will give you the information you need to plan so that when the approval letter arrives, you are ready!
Step 3: The Pre-Op Visit
Once we have approval, we will schedule your surgery and the pre-op visit for 2 weeks before the surgery date. Please note that I do breast reduction surgery on Wednesdays at two outpatient surgery centers here in Columbus: the Knightsbridge Surgery Center in Upper Arlington and the Central Ohio Surgical Institute in New Albany. If you have a preference, be sure to let us know.
The pre-op visit is comprehensive, with about 30 to 45 minutes spent with the nurse educator, who will give you your handbook, the soap you need to use, the compression socks, and the sequential compression devices for you to use after surgery. To make it as easy as possible for you, we have the bras you will need and some other swag! (Read our related blog post to learn more about preparing for your pre-op visit and scheduling your surgery.)
I will meet with you at this time to go over the surgery with you again. Then, you will be all set for your big day!
We’re Here To Help!
One of the reasons I love doing breast reduction surgery is that it changes the patient’s quality of life for the better—and most of my patients hug me! (Note: I am a hugger!)
You cannot change the size of your breasts on your own, or you would have already done it, so we at Aesthetica are ready to help guide you on this journey. Just call us at (614) 569-2649 to get started or use our online form to reach out.
Breast wishes to you!
Leave a Reply