Do I Need A Referral For Breast Reduction Surgery?

Q: Dr. Eppley, I have been waiting for my family physician to get me a referral to a plastic surgeon to consult me on a breast reduction. I have several health reasons for considering this type of procedure. I have a bulging disc along with deterioration of the tail bone and arthritis of the spine. I am about 50 pounds over weight, but have lost around 80 pounds in the last year or two. I have diabetes and kidney stone disease, so my losing weight was a must and I thought my pain would get better, but it has not, because I haven’t really lost any of my breasts. I would love to get a consultation with you, but I do not have the money to pay out of pocket and would like my insurance to pay for this procedure. That is why I wanted a referral so the insurance understands that it is not for cosmetics. What do you recommend for me to do in my situation. Thank you very much!

A: When using insurance you have to go through the proper channels (by the book) as this will ultimately effect the pre-determination process and decision for breast reduction surgery by your health insurance carrier. So you are going to have to get the referral from your family physician first before you can have a consultation. Most certainly they are never going to pay for a consultation without the referral.