Breast reduction surgery is performed when the patient is suffering from severe back pain, neck pain or shoulder pain. The excessive weight on the breasts of the females causes more pressure to their tender bones and muscles. This can also lead to being overweight or even the body might look saggy.
In order to cope up with such sufferings, a woman can either exercise a lot, or else opt for breast reduction surgery, which is a more permanent way to get rid of the pains and sufferings.
Breast reduction surgery comes under cosmetic surgery, that is, plastic surgery. You’ll need a good and experienced, certified plastic surgeon to help you with it. Before visiting the surgeon, you can actually visit your personal doctor for consultation and alternatives.
When it comes to insurance, your health insurance company might hardly pay you for cosmetic surgery. They had to be convinced that you’re facing real issues due to the weight and size of your breasts. It’s hard but not impossible. If you have enough evidence and reports, and if your physician is able to raise a strong appeal, the insurance company might just grant partial or rarely a full cover for the breast reduction surgery.
Here are a few tips for how you can write a more appealing letter for claiming the cover for breast reduction surgery, which will be hard to deny for the insurance company-
Remember that the letter claiming for the insurance cover will be written by your physician.
1) Keep the letter formal. Do not try to use informal or semiformal words. A formal letter is time-saving and informative to read and the companies prefer that.
2) Write the correct details, that is the details and insurance policy number, etc.
3) Write the subject after the address and highlight it.
4) Introduce yourself and how long you’ve been with the patient and what is your patient’s policy number.
5) Introduce all the symptoms of illness or pain your patient is going through.
6) Share details regarding which hospital or clinic you work in, what all tests it took in order to diagnose the issues, and what is the cure for it.
7) Explain in detail the surgery (in this case, the breast reduction surgery) and how it will cure your patient.
8) Explain what will be the procedure of the operation and how much it’ll cost considering your fees, infrastructure fees, medication, anesthesia, etc.
9) Add copies of the performed tests and highlight everything needed on those copies.
10) Try to provide as much detail as possible for them.
11) Try to use simple language which should be comfortable even for a layman to read.
Keep these tips in mind while writing the letter and that should just do the trick.
Here’s an example of how you can write a letter to the insurance company claiming cover for your patient’s breast reduction surgery-
From-
Physicians name,
Patient’s name,
Patient’s address and insurance number.
To-
The concerned person,
The health insurance department,
Address of the health insurance department.
Subject– To claim the cover for the breast reduction surgery of my patient (patient’s name).
Sir,
I’m a physician and personal doctor of MS.(patient’s name) and I’m writing this letter on behalf of the tests which we perform for her chronic pains and sufferings which she has been going through.
In the second paragraph, provide all the details about when and how the pain started. How long you’ve been treating her and what all medications you have provided so far. Continue by talking about the tests you asked her to perform to find out why the pain doesn’t seem to be reducing.
In the third paragraph, provide the results of the tests that have been performed and what they cost. Provide proper date and time of the tests and the results.
In the fourth paragraph, provide the details of what needs to be done. What will breast reduction surgery focus on doing and what will be the perfect time and date to do it.
In the fifth paragraph, provide assurance that this surgery will surely resolve the sufferings of the patient and give details why this surgery is imperative at this stage.
In the sixth paragraph, ask the insurance company to kindly approve the claims so that you can begin with the procedures of the surgery.
Yours sincerely,
Physician’s name.
You can ask your physician to follow this format to avoid any misunderstanding or delay in the procedure.
Keep in mind when writing a letter for an insurance company to pay for breast reduction
As breast reduction surgery comes under cosmetic surgery, it is tough to get a cover, but through this format, you should be able to get your cover and will save you a significant amount of money.
In case your claim gets denied, call the customer service team and ask them what more details you can provide in order to get your claim approved.
Do not panic, you can try the same procedure twice with more details, and if still denied, you can actually try to escalate it with a higher team.
Many insurance companies don’t provide cover for plastic surgery. But again the benefits may vary from plan to plan or company to company. Make sure you’re buying the right plan which covers most of the things that can ever happen to you.
Or you can actually exercise from an early age and avoid going through all of these troubles.
See Also…
Learn how to negotiate a settlement with an insurance claims adjuster?(Opens in a new browser tab)
The Advanced Guide to How To Write Off Bad Debt In Quickbooks(Opens in a new browser tab)