According to a press release on eurekaalert.org from the American Society of Plastic Surgeons (ASPS) “many insurance companies are denying thousands of women the procedure each year because of rigid, unfounded conditions to secure coverage.” This information was from a study presented at the ASPS Plastic Surgery 2006 conference in San Francisco.
Logically a woman with large breasts could have problems with daily activities from exercising to simply keeping up with your children. The co-author of the paper Michael Wheatley, MD said:
People often think breast reduction is an elective cosmetic procedure, but the majority of women seeking this surgery are legitimately debilitated by their breasts. The plastic surgery prices for breast reduction are sky high, and many of these women must remain in pain because they can’t afford to pay for the surgery. 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.
The main area of contention seems to be the amount of “tissue removed to relieve symptoms associated with overly large breasts.” The authors of the paper reviewed “policies of 87 health insurance companies” and found “49 of these companies require a minimum amount to be removed independent of the patient's height and weight.”
Many insurance companies “require that patients exhibit all of the following symptoms to receive coverage for breast reduction: back, neck, shoulder, and arm pain; rashes; bra strap grooves; and numbness in the upper torso.” Not surprisingly the authors of the paper find that most patients do not suffer from all of these symptoms.
Most women in need of breast reduction surgery are not going to have all or even half of the aforementioned symptoms many insurance companies are requiring. If a woman only has severe back pain that is preventing her from living a pain free life isn’t that enough proof that the surgery should be covered?
Let us know your thoughts and experiences on this topic.
I was denied covered for a much needed reduction with all the symptoms listed above. The claim had been sitting on the desk of one of the reps for 2.5 months. I finally called BCBS and was told that the claim had not been processed and I would get a response in 7 business days. Well 3 days later I got a denial letter in the mail. I was told they wouldn't cover it. I didn't try other measures such as chiropractor to relieve pain. Chiropractor in my opinion is only a temporary source of relief for someone who noticeably needs the reduction surgery. I don't where to go from here, my back pain is getting worse. How/Can I appeal this decision. I felt like the claim wasn't taken seriously because it had been sitting on someone's desk for a couple months and needed to be processed right away at the expense of my health. What can I do?
Posted by: Nick | March 30, 2007 10:46 AM | Permalink to Comment