Monday, June 13, 2016

Getting Insurance Approval for Breast Reduction

Hi everyone! Phew. It’s been a long few months since I last posted. It’s been quite the journey to where I am now, but before I share the story, I’ll share the news: I finally got approval for the reduction surgery! The date is set for next week. Eeep!

Getting insurance approval for breast reduction is… quite a process.

If you’re considering a reduction, the first thing you need to do is talk to your primary care doctor about back pain. Get documentation of it being a problem as early as possible. Get whatever tests your doctor thinks are necessary done to rule out any other causes, and start going to physical therapy if at all possible. Chiropractic and massage can also be good options. It’s important to have documentation of all relevant treatment options you’ve tried in order to manage your pain. As I’ve previously mentioned, I’ve been seeing a physical therapist for many months, which was important to my getting approved. I was also taking Aleve (naproxen) nearly daily to manage my pain, and made sure to mention that to my doctor. Taking NSAIDS such as Advil or Aleve long term can cause serious side effects, so both my insurance and doctor were concerned about getting me off of them as quickly as possible.

My doctor is a D.O, or Doctor of Osteopathy. Osteopathic doctors can be great for issues like back pain, since they have full credentials as medical doctors, but extra training in, and focus on, structural issues of the body such as skeletal and muscular issues. I feel that her skills in this area gave her a better sense of whether or not a reduction could help me. She asked me specific questions about my pain and felt along my upper back and shoulders, accurately predicting where I hurt most just by touching me and feeling the tension in my muscles. She has been nothing but enthusiastic about the idea of a reduction and believes it will really help me.

My doctor suggested several plastic surgeons in the area who she thought highly of, and I did some research and picked the one who felt best to me, who had good reviews and used the surgical technique that I wanted. Then she sent in the referral.

I needed a lot of documentation in order to get approved. I had to submit letters from my doctor and physical therapist as well as extensive notes and medical records. Different insurance companies have different requirements, and your surgeon can guide you through the process of gathering and submitting everything you need. Ideally, everyone on your medical team will be supportive. If not, you may need to seek out another doctor.

Many insurance plans do not cover breast reduction surgery. Last year, my partner’s company used Aetna, and while they technically do cover breast reduction, they have a requirement for the amount of weight removed from each breast that is unusually high. So basically, they only approve it in extreme cases. Since we were able to switch my insurance over to Anthem Blue Cross at the beginning of the year, which has a more reasonable requirement, I was able to get approved.

We were really conscientious about the process and kept checking in with the insurance company. The surgeon’s office really appreciated that we did this and said that it helped things move faster and more smoothly. The patient is often in the best position to contact everyone and make sure communication happens. It’s especially useful that we were able to get direct contact information for someone helpful at the insurance company.The first time my surgeon submitted my application, the insurance company claimed they didn’t have it after all (they “lost” it, I guess?) and we had to re-submit. Then they wanted more information and to haggle with my surgeon over the removal amount.

It has taken a long time to get approved, but once things were through, scheduling the surgery has happened rather quickly. I’m excited about the possibility of getting rid of my shoulder pain for good, but also I’m understandably nervous. Wish me luck!


  1. I would really like to hear more about your experience with the process. I'm seriously considering having it done as well once I finish breastfeeding. Thank you so much for sharing as much as you have!

  2. Congratulations! My sister recently got it and was, surprisingly, approved by the insurance company immediately (being a nurse herself probably helped). She said she felt a difference immediately after waking up and has been nothing but happy about the results.

  3. Hey there!

    First of all congrats on getting the approval for your surgery - I know EXACTLY how awesome that feeling is, as I actually had mine done last week! The process is similar but different in the UK - basically you have to convince the Clinical Commissioning Group to approve the funding as a special circumstances case. I've pretty much been wanting it done for my whole adult life, and I had reached the end of my tether. I'm sure you know what I mean! Narrow back/large cups is the worst :( It does seem to be something of a postcode lottery so I'm really lucky I got approved, and extremely glad I applied when I did as I doubt there is any money left for anything at all, since the government has ripped apart all our public services in the interests of lining their pockets at the expense of the entire country...

    But I digress! (and apologise for the political ramble, it's just pretty horrific here right now :/)

    So, I applied about a year ago I guess, as had my initial consultation last December. I was initially scheduled for early March but they had to postpone due to a flu outbreak in the hospital.

    I was a 30HH/J depending on brand/ TOTM etc... I asked for a B cup, and I have to admit I was a bit disappointed when I came round after surgery and there was still quite a lot there. More than I had imagined anyway. I don't know yet what size they will settle at - as I'm sure you know, the swelling will take a few months to subside. At present, though they're pretty swollen and tender, they're probably somewhere round an F. I was told to buy a sports bra to wear afterwards so I bought some 32 C/D cup ones and of course I hadn't a hope in hell of getting them on! I bought a few cheap ones at the supermarket to tide me over for a few days, but I'm in search of a decently supportive non-underwired one - and that's how I came across your blog. I've always just tried a few on in the shops before, once I knew what to look for fitting-wise. Plus I had a good idea of what my size was to begin with! I haven't actually measured myself with a tape measure for years. I read somewhere in the blogosphere a method for measuring accurately, where you measure in a number of different positions (upright, leaning forward with spine parallel to the floor, lying on your back etc etc), and in fact that was what I was hunting for, but your method seems to work well enough, and takes into account the force of gravity on breast tissue (why in the name of god that's an alien concept to most bra fitters I will never know!), it's just logical!

    Anyway, I shall continue my hunt, but I just wanted to drop you a little hello as I saw the date of your post. If there's anything you want to know about my experience I'm happy to answer any questions.

    I can categorically state I have zero regrets though. Neck & shoulder pain has been practically non-existent (I do have an underlying shoulder condition so that's still there), but that constant weight and drag is totally absent. 1000% worth it :D

    All the best with your op :D

    Rosie xx


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