A MMH Forum discussion includes a report of a woman who found that her United Heathcare policy has an exclusion for breast reduction unless she has cancer.
With most health insurers, breast reduction is a covered procedure based on a minimum quantity of tissue for removal and symptoms such as back pain. I have not heard of a policy like this before, but new policies with exclusions are coming out all the time. This is just one more thing to check when you are buying health insurance: what it specifically doesn’t cover.
Insurance denials are a fact of life; a fact that your doctor doesn’t control. It is no small wonder that most of us profile carefully before we become contracted to an insurer. Deep in the confines of most insurance contracts are clauses that give all the control to the insurer. And you wonder why many plastic surgeons do primarily cash business?
John Di Saia MD