Breast reduction surgery is one lengthy process. This is because of how delicate the program can be at certain times. As a potential adopter of this process, you might be faced with how to go about this delicate process, hence why we have prepared this well-researched article that explicitly highlights how to write a letter for insurance companies to pay for breast reduction. To begin breast reduction surgery, it is important to obtain coverage from your insurance company. This is because of any possible turn-in events. How then do you go about obtaining this coverage from your insurance company? This and more will be highlighted below:
Contents
5 Steps on How to Write Letter For Insurance Company To Pay For Breast Reduction
Before you delve into the full process of the surgery, the steps below have to be followed closely on how to write a letter for an insurance company to pay for breast reduction
- Confirm The Status of Your Insurance Coverage
Before you begin to write or draft your letter, rich research has to be done to confirm the status of your insurance coverage. The specification differs across different Instances and specifications.
Some insurance companies exclude mammaplasty in their specification.
If your insurance company falls into this category, then you might not even be eligible for mere consultation talk more of surgery coverage. This part forms a very crucial part of the letter writing process
- Seek For Preauthorization
After you might have confirmed the status of your insurance coverage, what comes next on the list is seeking preauthorization.
This is important because a large percentage of insurance companies request your statement of complaint. This should be duly prepared and signed by the surgeon who is going to carry out the process. Also, this statement should include the result of physical findings by both the surgeon and the patient.
Physical findings include information about the estimated breast weight that needs removal upon which coverage can now be requested. This should also be done before any surgery schedule is set. This is because your insurance company might refuse to go through with the process if preauthorization is not done.
NOTE: If your insurance company rejects coverage applications based on the classification of breast reduction as a surgical process, you just reached out to your doctor for quick enlightenment, stating the subtle difference between breast reduction and aesthetics.
- Confirm and Inform Your Insurance Company of the Latest Update
Not all insurance companies are up-to-date when it comes to the standard procedures involved in break reduction surgery. This is why you must confirm if they are up-to-date and consequently inform them of evolving stances.
This will affect authorization based on the acceptability of criteria along with medical proof.
- Collect All Doctor’s Report of Your Symptoms
After completing step 3, you need to collect all the doctor’s reports. This includes a report of your physical changes and whole symptoms which are caused by the weight of your breast. You must duly take advantage of this as this forms the base determinant of your medical necessity. This is to ensure that your insurance company does not take advantage of the famed denial of coverage based on overweight issues.
- Document Picture Evidence of Your Breasts
Lastly, before you go through the process of writing, you need to take picture evidence of your breast. These pictures must be taken by the staff of your surgeon and then duly documented. Also, you must document your present height and weight at the time when the pictures were taken.
All the above-listed points form the base criteria and steps to follow when you want to write a letter to your insurance company to pay for breast reduction
Now that you know the steps to follow when you want to write a letter to your insurance company to pay for breast reduction, it will only be justifiable if you understand and know the eligibility requirements for breast reduction coverage.
Eligibility Requirements For Breast Reduction Coverage
The following are requirements for eligibility for breast reduction coverage by your insurance company:
- Medically Establish The Treatment
To be eligible for bread reduction, you have to establish that your procedure is medically essential and not just aesthetic.
2. You need to Establish Failure of Physical Therapy
This is important for eligibility as most insurance companies will request you go for physical therapy like therapy for pains and poster realignment.
Perfect Way To Present Case For Breast Reduction Coverage
- To start with, you will need to get in touch with a doctor so he/she can discuss your breast reduction issues with you.
- You will also need to get a record copy and tender a request for referral to doctors who can address your problem.
- You must have been keeping your weight in check for an extended period of time.
- Check for possible restrictions in your insurance plans
- Also, confirm if your intending doctor takes insurance as an option. This is because not all do.
- You must have undergone a physical examination with your physician.
- You just have run a full detailed medical history
Conclusion
We have discussed all you need to know about how to write a letter for insurance companies to pay for breast reduction. It is important to know that there is a high probability that your application will be successful. According to statistics, 72% of presentation has been authorized while insurance completely reimbursed about 80%. Your chances are even higher if you choose a surgeon with staff that can perfect the authorization process.