CIGNA
Breast reduction surgery treats many symptoms caused by macromastia or (abnormally enlarged) breasts and is a medically necessary procedure that can provide a better quality of life. If you have CIGNA health insurance, you may be eligible to have your breast reduction surgery covered by your plan by using your out-of-network benefits to work with a plastic surgeon of your choice in Dallas, Texas.
Achieve a Balanced, Refined Look
Insurance plans are usually classified as either HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). Most HMO plans do not offer out of network benefits whereas PPO plans may offer patients access to physicians that are not in their health care plan network via out of network coverage. Oftentimes insurance cards will specify if out of network coverage is provided. If you are not sure if you have out of network coverage or would like to learn more about your coverage options please contact your insurance carrier by dialing the number on your card.
In order to qualify for coverage for a breast reduction by CIGNA, you must meet certain criteria as outlined by their breast reduction coverage policy.
A breast reduction is deemed medically necessary when a patient’s macromastia (abnormally enlarged) breasts causes them to suffer physical distress that is not alleviated through non-surgical interventions. According to CIGNA breast reduction is only covered in women who are at least 18 years of age or who have completed breast growth and who suffer with documented symptoms (see below).
During your consultation at HIM & HER Plastic Surgery, Dr. Vitali Azouz will perform a history and physical and document any symptoms you may be experiencing from your symptomatic macromastia. Your plastic surgeon will also document any remedies that you may have tried in the past to treat your symptoms. After performing a physical exam and taking pictures your surgeon will determine how much breast volume that would be removed in order to improve your symptoms.
According to CIGNA coverage policy on breast reduction surgery. A patient must have all of the following documented symptoms that are unresponsive to medical management:
According to CIGNA coverage policy on breast reduction surgery, preoperative photographs must be submitted that show the presence of:
Using out of network benefits to cover your breast reduction may seem like a difficult step, however, our team at HIM & HER Plastic Surgery is here to guide you every step of the way. Selecting a board certified plastic surgeon who meets your needs and understands your goals makes the process worth it. A breast reduction is a life changing procedure that improves quality of life and body image.
After your consultation at HIM & HER Plastic Surgery, your plastic surgeon will write a letter of medical necessity to CIGNA. If your surgery is deemed medically necessary, CIGNA will provide a pre-authorization letter that approves your surgeon to perform the surgery at the designated facility in Dallas, Texas.
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