Insurance Denials in Reduction Mammaplasty: How Can We Serve Our Patients Better?

Abstract

All figures are projected. * Data unavailable in prior year. **87% of total 2017 breast implants were silicone; 13% were saline. ***Botulinum Toxin Type A numbers are of anatomic sites injected. ****Counts of procedures performed by ASPS member surgeons only. In 2000 figure included all animal bites.^I n 2000 figure included facial laceration repair.^^^I

Insurance Coverage of Reduction Mammaplasty: A Need for New Criteria

“…1 In the transgender community, this increased focus on the face could have substantial effects on facial gender recognition, leading to exacerbation of facial gender dysphoria. 2 Misgendering can compound the effects of transphobia experienced by this community, intensifying both discrimination and social isolation. With the increased challenges faced by the transgender community during the pandemic, including access to gender-affirming care and social support, worsening of gender dysphoria may have devastating outcomes.…”

Medical aids and breast reduction: an oxymoron

“…This problem is not unique to South Africa; even in the USA there is limited insight into this condition and what criteria should be met for the selection of appropriate cases. [1][2][3] Consequently, BBR is excluded as a benefit by many medical funders. [1][2][3] It is erroneously viewed as a cosmetic procedure performed by plastic surgeons to improve breast shape.…”

“…[1][2][3] Consequently, BBR is excluded as a benefit by many medical funders. [1][2][3] It is erroneously viewed as a cosmetic procedure performed by plastic surgeons to improve breast shape.…”

“…Many articles indicate that BBR is not a cosmetic operation, and that large breasts place stress on the upper spine, 2,6,7 leading to backache, shoulder pain, headaches as well as intertrigo. [1][2][3][4][5][6][7][8] There are three absolute sequelae of breast reductions -firstly, there is significant scarring, approximately 40-100 cm in length. 5 Secondly, it is highly likely that following the breast reduction, there will be long term reduced nipple sensation.…”

“…It is also well documented that some criteria still used by health insurers are totally obsolete. [1][2][3] There is now substantial research indicating that breast reduction not only alleviates the physical symptoms of macromastia (backache, shoulder pain, etc. ), but also improves the patient's quality of life irrespective of resection weight.…”