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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Muscle Pain, Stress, Tightness And Muscle Soreness From Neck To Ankle. Swelling In Breasts. Will Insurance Will Pay For Breast Reduction Surgery?

I suffer from muscle pain, stress, tightness, and muscle sourness from my neck joints to my ankle joints. I believe that the huge size of my breasts are causing the pain and swelling to become more severe as I grow older. Is this possible and do I stand a chance that my insurance company will pay for breast reduction surgery?
Mon, 11 Nov 2013
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Anesthesiologist 's  Response
Hello,
Welcome to Healthcaremagic.

Thanks for your query.
I have gone through your query and understand your concern.

Insurance coverage for breast reduction varies from state to state.
Every insurance plan is different, and I cannot tell you specifically whether you would be covered under your plan or not.
Some plans require a certain minimum amount of tissue be removed, usually based on your height and weight.
Some plans require a demonstration of failure to more conservative approaches such as physical therapy.
Some plans offer no coverage at all.
Your surgeon can ask your insurer for a predetermination of medical necessity to find out in your case.
This will usually require the submission of a letter describing your history, your complaints , the amount of tissue planned to be removed, and a photograph of your breasts.
Most carriers require a letter from the plastic surgeon estimating the amount of breast tissue to be removed, so the letter from your primary care physician will not contain sufficient information to allow them to make a decision.

Hope this helps.
Please reply for further queries.
Wishing you good health.

Regards,
Dr.Manjeth kumar.
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Muscle Pain, Stress, Tightness And Muscle Soreness From Neck To Ankle. Swelling In Breasts. Will Insurance Will Pay For Breast Reduction Surgery?

Hello, Welcome to Healthcaremagic. Thanks for your query. I have gone through your query and understand your concern. Insurance coverage for breast reduction varies from state to state. Every insurance plan is different, and I cannot tell you specifically whether you would be covered under your plan or not. Some plans require a certain minimum amount of tissue be removed, usually based on your height and weight. Some plans require a demonstration of failure to more conservative approaches such as physical therapy. Some plans offer no coverage at all. Your surgeon can ask your insurer for a predetermination of medical necessity to find out in your case. This will usually require the submission of a letter describing your history, your complaints , the amount of tissue planned to be removed, and a photograph of your breasts. Most carriers require a letter from the plastic surgeon estimating the amount of breast tissue to be removed, so the letter from your primary care physician will not contain sufficient information to allow them to make a decision. Hope this helps. Please reply for further queries. Wishing you good health. Regards, Dr.Manjeth kumar.