Please read all information below before scheduling an appointment
Please fill out the Privacy Notice and New Patient Form prior to arriving for your consultation
If you are a breast reduction patient, please read the following information before scheduling an appointment:
Dr Mistry requests that all patients read the following information to be sure that they meet basic guidelines for breast reduction before scheduling a consultation. The preauthorization process is very time consuming for Dr Mistry and her staff and she reserves the right to insist that patients meet minimum preauthorization standards before initiating the preauthorization process.
Check with your benefits coordinator or call the insurer directly to determine if your policy has an exclusion for breast reduction surgery. An exclusion means that your policy will not cover breast reduction under any circumstances. Dr Mistry’s office can provide you with an estimate of pricing if you wish to proceed with surgery and pay for surgery yourself.
Breast reductions are sometimes covered by insurance, but only if preauthorization requirements are met. A breast lift is a breast surgery that removes excess skin and tightens the remaining skin around the breast tissue to elevate the breast to a higher, more youthful position. A breast reduction is a breast lift that also dramatically reduces the existing breast volume to lift the breast AND make it smaller. A breast lift is a cosmetic procedure. Insurers want to make sure that a breast reduction is treating specific symptoms and making a significant change in size, ie is more than a lift.
Each insurer has its own criteria for preauthorization. Most require some or all of the following:
BMI of 30 or less
Documented history of a year or more of neck, back and shoulder pain, not attributable to other medical issues, that has not responded to non-surgical interventions such as:
Special bras with padded straps
Physical Therapy for 3+ months
Chiropractic Therapy for 3+ months
Chronic rashes under or between the breasts that have not cleared with careful hygiene and medicated creams
Poor posture or kyphosis
Numbness or Tingling in the hands
In addition, each insurer requires a specific reduction in the volume of the breast. Each will specify how many grams must be removed in order to qualify. This amount may be determined by a calculation based on height and weight (Schnur Criteria) or may be an arbitrary amount set by the insurer. Dr Mistry will estimate how much volume can be removed without disfiguring the breast at the initial consultation. After surgery, the insurer will verify that the weight of the actual specimen meets preauthorized criteria. If the specimen is not heavy enough, the insurer may deny the claim after the fact.