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
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