According to a study presented at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco this week, many insurance companies are denying thousands of women the procedure each year because of rigid conditions to secure coverage—despite scientific studies that outline the medical necessity for breast reduction.
“People often think breast reduction is an elective cosmetic procedure, but the majority of women seeking this surgery are legitimately debilitated by their breasts,” says Michael Wheatley, MD, an ASPS member surgeon. “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.”
The authors of the study reviewed the breast-reduction policies of 87 health insurance companies. Despite medical findings to the contrary, 85 of the companies require a minimum amount of tissue to be removed to cover the procedure—and 49 companies require a minimum amount to be removed independent of the patient’s height and weight.
According to the report, insurance companies require that patients exhibit all of the following symptoms to receive coverage for breast reduction: 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 of them.
Wheatley says that many women have tried various treatments, including physical therapy and pain medications, to manage the pain before turning to breast reduction. Unfortunately, the women are still turned away by their insurance companies.
[www.medilexicon.com, October 11, 2006]