Q: I am 20 years old and I am a J cup. I have the WORST pain in my back, neck, and shoulders. I desperately need a reduction however I would need for my insurance to cover it. How do I begin? I have an appt with my new PCP but that’s not until Nov. 4th. Do I HAVE to go to a PCP and have them refer me to a plastic surgeon ? Or can I start by going directly to the plastic surgeon myself? And which doctor is the one that should write my insurance company? Any and all info is welcomed and appreciated.
A: I’m sorry to hear that your large breasts have been causing you physical discomfort. Your first step should be to contact your health insurance company about their coverage for breast reduction surgery. Each insurance company is different and has its own specific requirements. They can also tell you whether or not a referral is necessary and which plastic surgeons in your area are covered under your plan. It is a good idea to meet with your PCP. Most insurance plans require it. Your primary care physician will document your symptoms and check for physical findings like shoulder grooves and/or skin infections under your breasts. They can also examine your breasts and make sure there is no underlying medical problem leading to your overly large breasts. Most insurance companies require you to try non-surgical measures like physical therapy and non-steroid pain medications before they will consider covering plastic surgery and your PCP can help with that. Your PCP can also make sure that you are a good surgical candidate. Assuming you are still having discomfort after trying the conservative therapy, your plastic surgeon would submit the insurance pre-authorization letter. Best of luck to you!