Him Plastic Surgery

Blue Cross Blue Shield- Insurance Coverage For Breast Reduction Surgery

Name: HIM Plastic Surgery
Brand: HIM Plastic Surgery
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Blue Cross Blue Shield

Insurance Coverage For Breast Reduction Surgery

Breast reduction surgery alleviates many symptoms caused by hypertrophic (abnormally enlarged) breasts and is a medically necessary step toward a better quality of life. If you have Blue Cross Blue Shield (BCBS) 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 surgeon of your choice.

Achieve a Balanced, Refined Look

What are out-of-network benefits and how do I know if my plan has out of network benefits?

Insurance plans can broadly be categorized as HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). Most HMO plans do not offer out of network benefits whereas PPO plans can offer patients access to physicians that are not in their health care plan network via out of network coverage. Oftentimes insurance cards will specify out of network coverage. If you are unsure if you have out of network coverage or would like to learn more about your coverage options please contact your insurance carrier.

Does Blue Cross Blue Shield Cover Breast Reduction Surgery in Dallas, Texas?

In order to qualify for coverage for a breast reduction by Blue Cross Blue Shield, you must meet certain criteria as outlined by their breast reduction coverage policy.

What does Medical Necessity mean for a Breast Reduction According to Blue Cross Blue Shield?

A breast reduction is deemed medically necessary when a patient’s hypertrophic (abnormally enlarged) breasts causes them to suffer physical or psychological distress that interferes with their daily life and cannot be alleviated through non-surgical interventions.

What are the documented symptoms of Hypertrophic (Abnormally Enlarged) Breasts according to Blue Cross Blue Shield?

According to Blue Cross Blue Shield Coverage policy on breast reduction surgery, a patient must have some of the following documented symptoms that interfere with activities of daily living:

Pain in the upper back, neck and shoulders which is long-standing in duration and increasing in intensity and is not related to other musculoskeletal causes (e.g., poor posture, acute strains, post traumatic conditions, poor lifting techniques, or other evidence of overuse) OR
Persistent, clinical, and nonseasonal submammary intertrigo (rash) which is refractory and unresponsive to comprehensive local hygiene and topical anti-infective therapy, OR
Ulnar nerve paresthesia or compression, which results in pain and/or numbness in the arms and/or hands;

How Much Tissue Needs to be Removed to Meet Blue Cross Blue Shield Criteria for a Breast Reduction?

Blue Cross Blue Shield uses the Schnur Sliding Scale to determine the required amount of tissue that needs to be removed to qualify. This scale uses a patient’s body surface area (body weight and height) to determine the weight of breast tissue to be excised. This amount must be greater than the 22nd percentile of the Schnur Sliding Scale nomogram chart.

How to Use Blue Cross Blue Shield Insurance to Cover a Breast Reduction in Dallas, Texas?

During your consultation at HIM & HER Plastic Surgery, your plastic surgeon will perform a history and physical and document any symptoms you may be experiencing from your hypertrophic breasts. Your plastic surgeon will also document any remedies that you may have tried in the past to alleviate 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 alleviate your symptoms.

How to Obtain a Letter of Medical Necessity and Preauthorization for a Breast Reduction with Blue Cross Blue Shield Health Insurance?

After your consultation at HIM & HER Plastic Surgery, your plastic surgeon will write a letter of medical necessity to Blue Cross Blue Shield. If your surgery is deemed medically necessary, Blue Cross Blue Shield will provide a pre-authorization letter that approves your surgeon to perform the surgery at the designated facility.

Getting Your Breast Reduction Covered Using Out Of Network Benefits with HIM & HER Plastic Surgery

Using out of network benefits to cover your breast reduction may seem like a difficult task. 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 worthwhile. A breast reduction is a life changing procedure that improves quality of life and body image.

Schedule Your Personalized Consultation at HIM Plastic Surgery

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Dallas, TX

7777 Forest Lane Building C
Suite 802
Dallas, TX 75230
(469) 507-3446

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Fort Lauderdale, FL

17160 Royal Palm Blvd
STE 4
Weston, FL 33326
(469) 507-3446