Patients assume that if a surgery is classified as reconstructive, it is medically necessary and will be paid by insurance. Many patients, on the other hand, believe that if an operation is considered aesthetic, it is neither medically needed or covered.
Breast reduction, on the other hand, is often classified as a cosmetic procedure for insurance purposes until the patient can demonstrate a sufficient number of health difficulties and attempts to address those issues prior to undergoing corrective surgery. Once the threshold is met, the insurance company may consider breast reduction to be a reconstructive treatment for that patient and pay for it. The issue is that each insurance company or insurance company reviewer may have a different threshold. Breast reduction surgery has long been regarded of as a “hybrid” operation, in my perspective. It is classified as reconstructive in order to qualify for insurance coverage, but it is also classified as cosmetic in the sense that consumers anticipate thorough aesthetic skill in their surgery and results.
In our clinic, obtaining insurance reimbursement for breast reduction surgery has become increasingly challenging. Before considering coverage, insurance companies often demand 2-3 written reports from other referred specialists. In addition, insurance companies frequently need proof and treatment from a physical therapist, chiropractor, dermatologist, or orthopedist for 6-12 months.
What does this entail for a patient who requires the operation due to macromastia-related chronic health issues? During this procedure, keep yourself up to speed on policies, as the insurance company’s criterion this year may not be the same next year.
If you believe you are a candidate for breast reduction surgery and want your health insurance to cover it, you should contact your health insurance provider and request that they send you their coverage criteria in writing. Each insurance business has its own set of criteria and indicators. While your next-door neighbor with a seemingly less serious problem may qualify for the operation through one insurance carrier, you may not receive the same response from yours. To qualify for insurance coverage for breast reduction, it takes an average of 3-6 months of preparation, including secondary visits with other healthcare specialists and possibly therapy (physical therapy or chiropractics).
How can I get my insurance to cover my breast lift?
Breast lifts are not covered by all insurance providers, and even those that do aren’t covered in all circumstances. The medical need of the surgery is usually the deciding factor. If the procedure is deemed medically essential, the insurance company may pay for it. This is especially true for women who require breast reduction surgery because their breasts are giving them other health problems. In some cases, a breast lift is also required to assure the effectiveness of the breast reduction surgery, and the insurance company may pay both procedures.
It doesn’t always matter whether you or your doctor think the operation is medically required to persuade an insurance company. It’s worth taking a few extra measures to check if you can have a breast surgery preauthorized to see if your breast lift is covered by insurance.
- Examine your insurance benefits paperwork to check if certain treatments, or breast reductions or lifts in particular, are mentioned. Keep in mind that these policies are often written in legalese, which can be confusing, so calling the insurance company to ask for clarification is usually a good idea.
- If you think your insurance company would cover your breast lift, have your doctor produce a note of medical necessity. Provider offices will typically understand what is required in such a letter and may have previously worked with the insurance company. If necessary, work with your provider to make this procedure easier.
- Find out what documentation your insurance company need for preauthorization by speaking with a caseworker or pre-authorization representative. This is your insurance company’s formal (often written) acknowledgement that it approves services to be done and that it will cover the treatment as long as all preauthorization standards are met.
- Speak with your provider to ensure that the office understands what evidence is required to make good on the claim and that they are prepared to charge it correctly.
- Check to see if the surgeon is part of your insurance plan’s network. Going out of network can result in a loss of coverage or a significant increase in the amount you’ll have to pay.
- Make sure you understand your copay and deductible amounts. Even if the operation is covered, you may still be responsible for a percentage of the cost.
Whether or not your breast lift is covered by insurance, inquire about financial arrangements with your provider’s clinic. You might be able to set up a payment plan, and if you don’t have insurance, see if there are any reductions for paying in full at the time of service.
Does a breast reduction include a lift?
A breast lift is not included in breast reduction surgery. A breast lift is included in all breast reduction operations. After the extra tissue is removed in a standard breast reduction, the nipple is lifted to a more suitable position as part of the redraping process.
What is a good age for breast reduction?
While individuals in their mid teens can typically get breast reductions safely and successfully, many cosmetic surgeons recommend that patients wait until they are at least 18 before having the treatment. This is due to two factors:
- Breast development frequently continues throughout adolescence and may not be complete until your early twentiesnot exactly what you want to hear if your breasts are currently too bigbut waiting until you are fully matured can help you prevent the need for a second breast reduction in the future.
- Your cosmetic surgeon will want to make sure you’re emotionally prepared for surgery before proceeding. A breast reduction can be a very good experience, but the adjustment to your new body shape can be emotionally draining. You must demonstrate that you can handle the regular ups and downs of recuperation and that you have realistic surgical expectations.
This isn’t to imply that receiving a breast reduction before the age of 18 is impossible, especially if your breast size-related complaints are severe, but you should expect to hear “not yet” if you’re in your early teens.
How do you pay for a breast lift?
The cost of augmentation mammoplasty will vary depending on whether it is a cosmetic or a medical treatment.
Your insurance should cover breast implants if you have had a mastectomy due to breast cancer. Other medical issues, such as asymmetry, are frequently covered as well. However, if you’re having the treatment for cosmetic reasons, you’ll almost certainly have to pay for it yourself.
Credit card
Check to discover if your credit card’s credit limit will pay the entire procedure or only a portion of it. Make sure the card you’re using has a low interest rate as well.
If you’re considering getting a new credit card to pay the surgery, seek for one that offers a 0% introductory offer. The chance of receiving cash back or points on your purchase is an extra benefit of paying with a credit card. To see what you’ll get back using your card, learn how your issuer classifies medical treatments. Make sure you have a repayment plan in place to preserve your credit score and any debts in good standing.
Personal loan
Taking out a personal loan to pay for your breast augmentation is another possibility. A personal loan is an unsecured loan for a certain sum that is intended to assist in the payment of a significant purchase. The interest rate on your loan is mostly determined by your credit score and annual income. If you have decent to exceptional credit, personal loan rates might be as low as 5.95 percent.
Health insurance
Breast implants that are part of a breast reconstruction are usually covered by most health insurance plans. The Women’s Health and Cancer Rights Act covers breast implants following a mastectomy for breast cancer. This law requires insurers who provide mastectomy benefits to cover the reconstruction of the breasts removed during surgery, as well as the implants themselves.
Poland syndrome is another medical condition that is usually covered by most insurance plans. The operations in this situation are classified as breast reconstruction rather than breast augmentation. Breast augmentation is generally not covered by health insurance.
Health savings account
A health savings account, often known as an HSA, is a pre-tax account that is particularly intended for medical expenses. These accounts are available in conjunction with a low-cost, high-deductible insurance plan. When breast reconstruction surgery is required as part of breast cancer therapy, it is covered by an HSA. An HSA cannot be used for aesthetic operations that are not medically essential.
Patient financing plan
Most doctors are willing to work with patients to come up with a payment plan for their mammoplasty augmentation.
CreditCare is one of the most often used financing options. Over 200,000 healthcare providers in the United States accept CreditCare, a healthcare credit card. To see if your surgeon accepts CreditCare, look it up in the online database. The average annual percentage rate (APR) for this service is roughly 26.99 percent, though charges vary by account.
How do I qualify for a breast reduction?
Breasts that are too big might create health and emotional issues. You may also endure physical pain and discomfort in addition to self-image concerns. Excess breast tissue can make it difficult to maintain an active lifestyle. Emotional distress and self-consciousness are frequently associated with large pendulous breasts, and they can be just as problematic as the physical discomfort and agony.
The weight of your breasts causes pain in your back, neck, and shoulders.
How much is a breast reduction 2020?
According to 2020 figures from the American Society of Plastic Surgeons, the average cost of a breast reduction (for cosmetic purposes solely) is $5,913. This is only a portion of the entire cost; it excludes anesthesia, operating room facilities, and other related costs.
How painful is breast reduction and lift surgery?
It’s common to feel some pain and discomfort in the days following your surgery. It’s possible that your breasts and the areas around them will be bruised and swollen. This is due to the stretching of the breast tissues and muscles.
The first few days after surgery are the most painful for most women. Your doctor may prescribe pain relievers if necessary to alleviate the discomfort.
Additionally, drainage tubes may be inserted on your breasts as part of the recuperation procedure to help reduce swelling. These are frequently removed after a few days of surgery.
Women recovering after breast reduction should wear specific surgical bras to protect the tissue during this time, according to medical specialists. Finally, throughout this time, it’s critical to avoid overly vigorous activity.
Does Bcbstx cover breast reduction surgery?
Reduction Mammaplasty operations performed for cosmetic reasons will not be covered unless documentation of medical need is provided. There should be no promise of coverage for PREDETERMINATION REQUESTS unless paperwork has been received and examined to establish the medical necessity.