Insurance Companies Deny Medically Necessary Breast Reductions

Armen Hareyan's picture
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Breast Reduction Surgery and Insurance

What if you couldn't perform daily activities, such as exercising or running with your children, because of overly large breasts that caused unending pain? Despite existing scientific studies that outline the medical necessity for breast reduction, many insurance companies are denying thousands of women the procedure each year because of rigid, unfounded conditions to secure coverage, according to a study presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco.

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"People often think breast reduction is an elective cosmetic procedure, but the majority of women seeking this surgery are legitimately debilitated by their breasts," said Michael Wheatley, MD, ASPS Member Surgeon and paper co-author. "The criteria most insurance companies use is not supported by medical literature and eliminates a large number of women from coverage, forcing them to fend for themselves."

Most insurance companies require patients to exhibit specific signs and symptoms prior to approving breast reduction as medically necessary. The amount of tissue removed to relieve symptoms associated with overly large breasts is the most controversial of all insurance criteria.

The authors reviewed the breast reduction policies of 87 health insurance companies. Despite contrary medical studies, 85 companies require a minimum amount of tissue to be removed to cover the procedure

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Comments

I recently consulted a physician about reduction ., I am 5 ft tall and I wear 36 double DD and this is bec. this is the last size of cup bra I can find. I am still waiting for insuranc see if I get covered. Unfortunately I suffered a lot of back pain and worst my balance is getting off bec. of this heavy loan I carry. I recently had back pain and is diagnose of degenerative L4 and L5 i suffered a lot of back pain I cannot get out of bed. the doctor assigned me for physical therapy and the goal is to be able to take off the pain with the therapy. Well It probably will for a few days. Imagine if you hold up a 20 pounds weight on both of your hands How long you think it will last until your arms get weary and tired and stiff. Well that is what I feel with my back and neck pain I feel like I have been carrying load forever and have 2 kids add more weight on them. Yes I feel like one of those misfits when I looked for clothes to buy at any store bec. the chest is always a problem to fit yet my arms are not too big to go to the womens big size. They were ok when I was young and single men really get attracted to them but I always feel that that attraction sometimes getting disrespectful comments. My posture is getting bad as I grew older it seems I am starting to be looking more like a hunchback. I just hope medical insurance would cover this. Yes I can't exercise jogging makes them painful after a few minutes, walking is all what I can do even that give me back pain after a while. I am going to my physical therapy I think I will add up more insurance bill on this alternative care than taking care of the real problem. Thank you for those who have concern about this matter.