Letter for insurance company to pay for breast reduction

I won’t lie to you. It can be quite difficult getting an insurance company to pay for either a labiaplasty or vaginoplasty operation. Plastic surgery in general tends to be considered elective surgery, and so the insurance companies aren’t as quick to pay for these. And even less so for these two particular operations. However, a few people have managed to get insurance to cover it by writing a convincing letter to the insurance company. Here’s what you need to know.

First, you need to make your original request for the insurance company to cover the procedure. They’ll probably deny it. That’s when you write a letter of appeal. Start with something like: “This is my written appeal responding to ALLSTATE’S refusal to cover my proposed labiaplasty, dated _____.” Next, state why the company declined coverage. “You stated this was because this was elective surgery, not covered by my policy. Attached you’ll find a copy of my original request and your denial.”

Now make your case: “My requested labiaplasty is not for mere cosmetic purposes, but because of physical discomfort as well as difficulties I might have professionally. Allow me to explain using some frank language. In many cases, someone with oversized inner genital lips experiences irritation and pain while doing normal activities such as exercising or riding a bike. This is true in my situation, and is what a labiaplasty will resolve. Also, this oversized condition is sometimes noticeable through certain clothing, proving embarrassing at professional situations. I assure you, my interest in a labiaplasty is not due to any vanity or untoward motives….but only because it will help me operate more correctly and comfortably in my everyday life.”

Here’s where you really need to not be shy, because you need to include photos:

“I am enclosing photos showing the issue which I hope to resolve through this medical procedure. I’m convinced a labiaplasty is the only way of resolving these issues I’ve mentioned above. Please feel free to contact me with any questions you might have. I assure you, this procedure is medically indicated, not cosmetic.”

Hopefully a letter such as this will help at least some of you receive coverage. Disclaimer: Understand that I am not offering legal advice, but only telling you that a similar letter as this has helped some women get coverage for their labiaplasty.

Are you overwhelmed or self-conscious about large, heavy, and oversized breasts? Do you feel restricted or inhibited by your large breasts from doing everyday normal activities that other Long Island women can enjoy? Our board-certified plastic surgeons at Romanelli Cosmetic Surgery can help you improve your lifestyle with a cosmetic procedure called breast reduction surgery.

Many women think about having their breast size reduced, but simply do not know what their options are, or if they can afford it. We are happy to inform you that there are a number of options to create a normal, lighter breast appearance and many cases, this surgery can be covered by medical insurance. Read on for more information!

Am I A Candidate?

Breast reduction surgery, also known as reduction mammoplasty, is a procedure that is available to Long Island area women who have excess breast tissue, skin, or fat removed to reduce their breast size. Women with large or extremely large, heavy breasts (also known as macromastia) deal with physical as well as psychological limitations when it comes to this issue. Finding the right clothes that fit or worrying about people staring at them can have a dramatic effect on a person and their well-being. Even doing simple tasks like putting on a seatbelt or trying to sleep on your stomach, much less going for a run or playing a simple round of golf can be issued for women dealing with large breasts.

Solution:

A solution to this issue is to consider having a breast reduction surgery. Women with large breasts already deal with the issue of sagging (ptosis) due to aging, but add to that the general health issues that come with carrying large, heavy breasts can make daily life a struggle. Such health issues include:

• Poor posture, which can cause head, neck, and shoulder pain
• Skin rashes under the breast from constant contact with the stomach area
• “Grooves” in the skin of the shoulders from bra straps
• Labored breathing or inhibited lung capacity as large breasts sitting on the chest area can affect the lungs
• Weight gain is also a problem for women with large breasts as their ability to exercise is inhibited

With all these health concerns, there is a good reason why health insurance may cover or partially cover your breast reduction procedure in order to get you feeling healthier and feeling better about yourself.

Does insurance cover breast reduction surgery?

Breast reduction surgery is one of the few cosmetic procedures that health insurance will consider covering. Insurance requirements do vary by company and insurance plans, but usually, if a woman is experiencing the following their insurance might cover this procedure:

• Large breasts that could be reduced by at least 3 cups sizes or more (500g or more)
• Head, neck, shoulder or back pain that is not diminished by regular visits to a physical therapist
• If dermatological issues such as the painful “grooves” in the shoulders due to bra straps or having to wear 2 bras to support large breasts or rashes under the breasts are not able to be cured or treated properly without a breast reduction
• If an individual is not able to maintain a healthy body weight due to limitations in physical exercise or not being able to play sports due to their breast size
• Also if documented weight loss did not improve the breast size in order to give a person relief

For a pre-authorization to your insurance company, a letter of such documented issues must be submitted by your Long Island plastic surgeon or your general doctor. This can also require photographs documenting such issues like skin rashes or showing the massive nature of what the breasts look like for an individual. Some patients who can privately pay for their procedure choose to wait and not do a pre-authorization to their insurance company. They wait till after the procedure in order to have more freedom on what plastic surgeon they can choose and how much breast tissue or weight is removed since some insurance policies require a certain amount to be approved. Your plastic surgeon or general doctor can then submit before and after photos as documentation to your insurance company as well as what health issues you were experiencing.

Steps to ensure you are covered…

Unless you can privately pay for your breast reduction surgery it is recommended to do the following before your breast reduction procedure to see about insurance coverage:

• Check your insurance policy to see if such a procedure could be covered or partially covered to alleviate symptoms you are experiencing.
• Call your insurance company to see if a pre-authorization letter is needed for breast reduction surgery.
• Find out what documentation is needed by your regular medical doctor or a plastic surgeon in order to be considered for coverage or partial coverage.
• See if your insurance company needs a second opinion or medical exam by another general doctor or plastic surgeon in order for them to possible cover or partially cover the procedure.
• Find out if you need to use an in-network plastic surgeon of their choice in order to be covered or partially covered or if you can find your own doctor. Choosing the right plastic surgeon or doctor to do this procedure or any cosmetic surgery is the most important step in the process.

So the good news is that in some or most cases breast reduction surgery may be covered by your health insurance. Even though health insurance doesn't typically cover cosmetic plastic surgery unless to repair the body after an injury or accident, reconstruction surgery for breast cancer treatment, or fix a birth defect -- in some cases breast reduction surgery can be added to this list. If the end result is improving a woman’s quality of life or eliminating health issues due to having large breasts then it is an option and worth checking into your health insurance to find out if you are covered.

If you want to schedule a breast reduction consultation with one of our board-certified plastic surgeons at Romanelli Cosmetic Surgery in Long Island, NY call today for more information!

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