Local Plastic Surgeon in Paramus New Jersey, Dr. Andrew Nouri Educates Patients on Insurance Coverage for Medically Necessary Breast Reduction
What many people don't realize is that breast reduction surgery, also known as reduction mammoplasty is usually medically necessary, and as a result, it may be covered by health insurance.
'At Nouri Plastic Surgery we understand the pain and discomfort associated with disproportionately large breasts. We ensure the highest level of patient care from the moment you give us a call to your final post-operative visit'.
We are here for you, every step of the way. Our 'patients first' motto is unwavering. We are located in Paramus, Bergen County, New Jersey and very close to Franklin Lakes, Tenafly, Cresskill, Ridgewood, Englewood Cliffs, Woodcliff Lake, Alpine, Paterson, Saddle River, Ho-Ho-Kus, and Upper Saddle River, as well as New York City.
If you've been suffering from the physical and emotional burden of large breasts, you might be surprised to learn that your insurance provider could help cover the cost of surgery. Here's what you need to know.
When Is Breast Reduction Medically Necessary?
Insurance companies typically distinguish between cosmetic and medically necessary procedures. For breast reduction to be considered medically necessary, there must be documented evidence that large breasts are causing health problems or interfering with daily activities.
Some of the most common reasons include:
Longterm back, neck, and shoulder pain that doesn't improve with physical therapy or other conservative treatments
Skin irritation or recurrent infections in the fold under the breasts (intertrigo)
Shoulder grooving from bra straps
Restricted physical activity due to breast size
Emotional or psychological distress, such as body image issues or social anxiety
In these cases, breast reduction can dramatically improve quality of life. By removing excess breast tissue, skin, and fat, the procedure not only relieves pain and physical symptoms but can also restore balance to the body's proportions.What Insurance Plans Typically Require
Every insurance plan is different, but most follow similar guidelines when it comes to approving breast reduction surgery. While policies and terminology may vary, here are the most common requirements:
1. Documented Medical Symptoms
You'll need a record of your symptoms and how they affect your daily life. This may include notes from your primary care physician, physical therapist, or other specialists confirming issues like chronic pain, skin infections, or functional limitations.
2. Trial of Conservative Treatment
Insurance companies usually want to see that you've tried non-surgical approaches first. These might include physical therapy, weight loss, chiropractic care, better support garments, or medications.
3. Minimum Tissue Removal
Some insurers require a specific amount of breast tissue to be removed for the procedure to qualify for coverage. If your surgery meets or exceeds the threshold, you're more likely to get approval.
4. Photographic Evidence
During your consultation, Dr. Nouri will take photographs to document breast size and skin issues. These images are submitted to the insurance company by your plastic surgery team as part of the prior authorization process.
5. Letter of Medical Necessity
Your plastic surgeon will typically write a detailed letter explaining why breast reduction is necessary and how it will benefit your health. This letter is submitted along with the other documentation for insurance review.
How the Approval Process Works
Once all the necessary paperwork is gathered, your surgeon's office will submit a request for prior authorization to your insurance provider. This process can take a few weeks, and it may require additional information or clarification.
When approved, your insurance will cover a portion or sometimes the full cost of the surgery, depending on your plan, deductible, and out-of-pocket maximum.
If denied, you have the right to appeal the decision. Many patients are ultimately approved after providing additional documentation or going through the appeal process.
Choosing the Right Surgeon
When considering breast reduction, it's important to choose a plastic surgeon who has profound experience with both the procedure and insurance navigation. Dr. Nouri is an expert in reduction mammoplasty, specializing in both macromastia and gigantomastia, in which a free nipple graft may be necessary. Every case is different, and every patient is different.
Dr. Nouri prides himself on his customized approach to each patient, exceptional surgical technique, and impeccable bedside manner, all expressed in his Google reviews – over 140 5-stars! In addition, his office staff exemplifies the highest understanding of navigating the insurance process to get you preauthorization.
Benefits Beyond the Physical
The benefits of breast reduction are life-changing. Women report dramatic improvements in pain, posture, physical activity, and overall confidence. Clothing fits better, exercise becomes more comfortable, and daily activities no longer feel limited.
Emotionally, patients feel a renewed sense of freedom. No longer burdened by unwanted attention or discomfort, they can move through the world with greater ease and self-assurance.
Final Thoughts
If you've been struggling with the physical and emotional toll of large breasts, know that you are not alone and that help may be more accessible than you think.
Breast reduction surgery isn't just about appearance; it's about improving your health, comfort, and quality of life.
And yes it can be covered by insurance!
Call Dr. Nouri's office today to schedule a complimentary consultation to explore your options. With an expert team behind you every step of the way, you can take this empowering step toward relief, confidence, and well-being.
Always you. Always natural.Nouri Plastic Surgery16 Arcadian Way, Ste C7Paramus, NJ 07652973.200.2050www.nouriplasticsurgery.com
CONTACT: Nouri Plastic Surgery 16 Arcadian Way, Ste C7 Paramus, NJ 07652 973.200.2050 dr.nouri@nourips.com www.nouriplasticsurgery.comSign in to access your portfolio
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Forbes
31 minutes ago
- Forbes
Navigating Health Insurance After Job Loss: Is Short-Term Coverage Right For You?
Editorial Note: We earn a commission from partner links on Forbes Advisor. Commissions do not affect our editors' opinions or evaluations. Losing your job is stressful enough—sky-high health insurance costs shouldn't make it worse. With Affordable Care Act (ACA) plans averaging more than $500 a month, many newly unemployed Americans may find themselves scrambling to afford coverage once their employer-sponsored plan ends. With the unemployment rate ticking up to 4.2% in July 2025 from 4.1% a month prior, more workers risk losing not just their paychecks but also their health insurance . The rising unemployment rate can signal a cooling economy, making it more urgent for those newly out of work to find replacement coverage quickly. Losing your job doesn't just mean a loss of income—it can also leave you without health insurance, which is the last thing you want to worry about in uncertain times. One option people often look at is Continuation of Health Coverage (COBRA), which lets you stay on the same health insurance plan you had through your employer for up to 18 months. This might sound tempting, but there's a big catch: you're responsible for the full premium. This can easily push your monthly cost into the hundreds or even thousands, which isn't exactly doable when you're out of work. This is where another option comes in handy: short-term health insurance . Short-term health insurance is designed to fill the gap while you look for your next job. It's usually much cheaper than COBRA and can start almost immediately. But it comes with some serious trade-offs: Coverage is usually limited, and many don't include things like preexisting conditions, mental health care or prescription drugs. Affordability. Short-term plans tend to carry lower monthly premiums than COBRA or ACA marketplace plans, making them a more budget-friendly option when you're searching for new employment. Short-term plans tend to carry lower monthly premiums than COBRA or ACA marketplace plans, making them a more budget-friendly option when you're searching for new employment. Immediate coverage. Unlike ACA plans that may have waiting periods or restricted enrollment windows, short-term plans often activate immediately, even the next day, offering quick protection when you need it most. Unlike ACA plans that may have waiting periods or restricted enrollment windows, short-term plans often activate immediately, even the next day, offering quick protection when you need it most. Flexibility. You can typically choose the duration of your coverage—up to a few months—and cancel anytime without penalty, helping you tailor it to your specific job-search timeline. Limited coverage. These plans are exempt from ACA requirements, meaning they often exclude essential health benefits like preventive care, mental health services, maternity coverage and treatment for preexisting conditions. These plans are exempt from ACA requirements, meaning they often exclude essential health benefits like preventive care, mental health services, maternity coverage and treatment for preexisting conditions. High out-of-pocket costs. Many short-term policies come with steep deductibles, high coinsurance and coverage caps. Many short-term policies come with steep deductibles, high coinsurance and coverage caps. Regulatory restrictions. Recent federal rules limit coverage: plans issued after September 2024 can last only three months, with a possible extension to four. And depending on your state, these plans may even be prohibited, such as in New York, where short-term plans are not allowed due to state regulations that mandate renewability. If you're in decent health but have recently become unemployed and need coverage to hold you over for a bit, a short-term health plan might be a budget-friendly option. But be sure to read the fine print, as these plans often have exclusions, coverage limits and caps. While short-term coverage can bridge the gap, you may still want to consider an ACA marketplace or COBRA plan for more comprehensive, long-term insurance, especially if you have ongoing or greater health needs. As unemployment inches upward—now holding at 4.2%—many Americans find themselves at a crossroads: needing affordable, interim health coverage while seeking stable employment. Short-term health insurance offers fast, budget-friendly coverage that works well as a temporary bridge. However, it has trade-offs that you should consider before enrolling. Choosing the right healthcare coverage while between jobs can help maintain your peace of mind during an already stressful time. Forbes Advisor is not a licensed insurance agency. Insurance offerings are provided by CompareCoverage, NPN 20753534 and CA License # 6011227. © 2025 CompareCoverage. All Rights Reserved. Was this article helpful?
Yahoo
10 hours ago
- Yahoo
Mark Cuban: Healthcare Is ‘Too Expensive' — 3 Things That Can Be Done To Lower Costs
If you're shocked by everything from the cost of a new medication to the bill you received after surgery, you're not alone. Healthcare costs are only increasing and from paying for health insurance to simply covering your bills after an illness, it can be difficult to keep up. For You: Read Next: In fact, reports that treating a broken leg can cost $7,500, while a three-day hospital stay can total $30,000. Such expenses can take a toll. The Consumer Financial Protection Bureau reported that approximately 100 million Americans owed over $220 billion in medical debt. It's difficult to avoid rising healthcare costs, especially when you need care, but American businessman and television personality Mark Cuban might have some solutions — read on to find out. Why Mark Cuban Thinks Healthcare Is Too Expensive Mark Cuban highlighted the broken healthcare system in December 2024. He took to Bluesky, calling healthcare pricing 'horrific.' He said hospitals and doctors tend to bear the full financial burden when patients fail to pay deductibles, copays or coinsurance. To compensate for these unpaid amounts, they often increase their prices. Cuban explained that hospitals and doctors face administrative challenges in collecting those large amounts from patients and medical debt can lead to bankruptcy. Check Out: He also identified issues with the health insurance agency. Cuban explained that health insurance agencies don't actually provide insurance to those covered by self-insured entities, such as an employer that insures its employees and pays for their claims directly. While Cuban identified several flaws with healthcare costs, he also suggested three ways to lower your costs. Transition Away From Insurance Companies Approving and Denying Claims When a self-insured business hires an insurance company to review insurance claims, it's in the insurance company's financial best interest to deny claims, saving the business money. The business doesn't have to pay for services that are denied, which can ultimately boost their bottom line. Unfortunately, that also means that necessary services are denied, leaving patients to go without or pay for the services out of pocket. Instead of relying on insurance companies to evaluate claims and process payments, Cuban suggested that the process be performed by independent third-party authorizers which have no economic incentive to approve or deny health insurance claims. Cuban's idea is appealing and could address the conflict of interest that insurance companies have during the claims process. Until that idea or a similar one is implemented, your insurance company might deny your claim. The Patient Advocate Foundation offers some helpful advice on additional steps you can take if you receive a denial letter. Create Direct Contracts With Providers Cuban suggested that self-insured businesses — such as his business, Cost Plus Drugs — transition to contracting directly with healthcare providers. In such a situation, the business would pay for the entire cost of care immediately. 'There will be no out of pocket costs for employees when they use providers in our network,' he wrote. The process is simpler for employees and doesn't carry the stress of worrying about denied claims or having to change treatments based on insurance company approval. But it also benefits the business. 'In exchange, we ask the providers to charge us much less than they currently charge,' Cuban explained. Explore New Providers and Alternative Options Cost Plus Drugs is one example of how seeking out new providers can help you save money on your healthcare costs. In creating Cost Plus Drugs, Cuban cut out the pharmacies and instead negotiates directly with drug manufacturers. This unique business structure helps the business to get the best possible price on medication, saving you money, in turn. Cost Plus Drugs is also highly transparent about the pricing; they show you just how much you'll pay, including shipping, before you place an order. Their approach helps you plan ahead for your costs, rather than arriving at the pharmacy to pick up your medication without knowing how much you'll pay. Cuban's three solutions can help you save on your healthcare costs, though they'll take time to implement. In the meantime, you can potentially save on health insurance by shopping around and comparing plans during open enrollment. If your employer offers a Health Savings Account (HSA) or similar option, you can save pre-tax dollars to use to pay for medical costs. Don't forget to also use platforms like GoodRx to track and save money on your prescription costs. More From GOBankingRates 3 Luxury SUVs That Will Have Massive Price Drops in Summer 2025 5 Cities You Need To Consider If You're Retiring in 2025 10 Genius Things Warren Buffett Says To Do With Your Money This article originally appeared on Mark Cuban: Healthcare Is 'Too Expensive' — 3 Things That Can Be Done To Lower Costs Sign in to access your portfolio
Yahoo
16 hours ago
- Yahoo
People who get ‘Obamacare' health insurance are set to see premiums jump by 18%, study finds
People who receive health insurance through the Affordable Care Act, also known as Obamacare, are set to see their premiums jump by 18 percent, according to analysis of preliminary insurance rates. Under Obamacare, people who may not have health insurance through their employer but are not eligible for Medicaid can purchase health care on state exchanges. If they earn an income below a certain threshold they could be eligible for tax credits. The hike in insurance premiums is due to rising healthcare costs, inflation, uncertainty over federal policy changes and, potentially, President Donald Trump's tariffs, according health policy think tank KFF. The think tank analyzed filings from 312 insurers across 50 states and Washington, D.C. to state regulators detailing their expectations and rate changes for Obamacare plans for 2026. The increase in the median premium is more than double last year's 7 percent proposed increase and is the largest rate change health insurers have requested in five years, the think tank found. 'Tariffs could potentially put upward pressure on the costs of pharmaceuticals and medical supplies, driving premiums upward in 2026,' the report summarized. 'However, there is considerable uncertainty about how these trade policies will impact medical pricing, and insurers vary in how (or if) they factor tariffs into their rate development.' Tax credits for the Affordable Care Act will expire at the end of the calendar year unless Congress intervenes. Insurers also cited this is a factor in higher premium rates. 'The expiration of enhanced tax credits will lead to out-of-pocket premiums for ACA marketplace enrollees increasing by an average of more than 75 percent, with insurers expecting healthier enrollees to drop coverage,' KFF's report said. 'That, in turn, increases underlying premiums.' Experts warned that the increase in premiums is going to 'shock' a lot of Americans. 'I think there's going to be a lot of sticker shock of people who aren't following this debate in Congress and are going to be stunned by just how much their rates go up, because the premiums will increase substantially,' Jonathan Oberlander, a professor of social medicine at the University of North Carolina-Chapel Hill, told The Independent. 'They might not get employer-sponsored health care, but they're like realtors or entrepreneurs or small business owners or Uber drivers,' one former Capitol Hill aide who now works in health care told The Independent. 'These folks – going to the exchanges trying to purchase their health insurance, they're on the precipice of seeing a big cost of living increase.' Additional reporting by Eric Garcia.
