We have previously discussed the options to reduce breast size and emphasized that almost in all cases, women undergo this procedure not that they are vain, but because it is a medical condition. Tell that to your health insurance company, which is more interested in its bottomline rather than the health of its members (despite all the warm and fuzzy ads on television).
In the past, it is something that we had only heard from people who had written to us but now a study Dr. Michael Wheatley says that the criteria most insurance companies use is not supported by medical literature and eliminates a large number of women from coverage, forcing them to fend for themselves.
Most insurance companies require patients to exhibit specific signs and symptoms prior to approving the procedure as medically necessary. The amount of tissue removed to relieve symptoms associated with overly large breasts is the most controversial of all insurance criteria. (Related: Right age for breast reduction)
Despite contrary medical studies, 85 out of 87 companies require a minimum amount of tissue to be removed to cover the procedure – 49 of these companies require a minimum amount to be removed independent of the patient’s height and weight. According to published studies, although most patients have a one-and-a-half to two cup size reduction, the amount of tissue removed, body weight, level of obesity, or bra cup size do not affect the benefits that patients receive from the surgery.
Many insurance companies require that patients exhibit all of the following symptoms to receive coverage: back, neck, shoulder, and arm pain; rashes; bra strap grooves; and numbness in the upper torso. The authors found that while most patients suffer from many of these symptoms, rarely do they exhibit all. I wonder if there is a way to sue these companies.