Breast Reduction Surgery

[Guest Carolynn]

I haven't been able to find any information on this subject at all - I'm assuming that a letter from the doctor stating that the breast reduction operation is medically necessary due to ..... would be all we need to reimburse from the participant's FSA medical. Does anyone know any different?

Many thanks!

Carolynn

[Sandra Pearce]

If the surgery is medically necessary it would probably be reimbursable by the person's health plan. Then the 125 plan would be paying from an EOB which would show charge, payment, deductible, out of pocket, etc. like any other medically necessary surgery.

[Guest Carolynn]

Good point - but the doctor says it is necessary surgery and the insurance company has disagreed. The participant is still having the surgery done (for a dependent) but hopes it is reimburseable. Any other opinions out there? Thanks!

Carolynn

[Guest b2kates]

My daughter had reduction surgery this summer. After multiple appeals it was approved by the HMO.

Accordingly, if physicians state it is a medical need, then it would be reimbursable under a 125 plan and not considered elective cosmetic surgery.

[mroberts]

I would go along with what the doctor is saying as far as being medically necessary. Sometime you have to appeal a claim a few times to an insurance carrier to get them to pay for it. I would allow the procedure to be reimbursed under your Section 125 plan. I would also tell her to appeal the claim to the insurance carrier since most of the cost could be picked up by them.

[Guest Carolynn]

Thanks to all - I'm in agreement, as long as the Doctor says it's medically necessary we can reimburse. I also appreciate the information about insurance appeals - I'll pass that along.

Carolynn