United Healthcare Denies Breast Reduction Without Cancer?


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?

Best Regards,

John Di Saia MD

Related:

A United Healthcare POS Policy that excludes Breast Reduction on page 20

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Comments

  1. Terri says:

    UHC will not pay for my Breast reduction, because I do not have cancer. I have UHC Choice Plus plan and still got turn down

    1. admin says:

      Most health plans used to cover breast reduction if enough weight could be removed to improve pain in the back. Things have changed.

  2. admin says:

    Anon,

    Individual case managers frequently have discretion. The policies vary significantly, but I am happy you were able to get your operation covered.

  3. anon says:

    I have United and my BR was covered. You do need documentation – chiropractic or P/T type visits prior usually.

  4. Laura says:

    When I had a myomectomy my insurance company didn’t want to pay for it. They would only pay for me to have a hysterectomy, not to have my uterus repaired. The same insurance company would pay for Viagra but not for birth control pills. Some women need BCP to keep from bleeding to death every month. I find that more of a medical necessity than Viagra.

    When something like this comes up you have to go back to the insurance company and complain as well as complain to your employer. I complained to the insurance company as well as the company I worked for at the time. Afterward they started covering both the surgery and BCP.