How to get breast reduction covered by insurance [Kyle Baltrusch, MD, Portland]

Dr. Baltrusch (00:00):
My name is Kyle Baltrusch. I'm a plastic surgeon in Portland, Oregon.

Eva Sheie (00:04):
Okay, so let's talk about breast reduction a little bit. Portland Plastic Surgery Group is pretty well known around, I think, beyond the Portland area ,and really in the Northwest, for being one of the few places that takes insurance for breast reduction. Philosophically, can you maybe talk a little bit about why as a group you take insurance for breast reduction?

Dr. Baltrusch (00:26):
We've had a very good success rate with insurance providers for covering breast reductions, but it's also probably one of the leading procedures that we do at this office, I know it's the leading procedure that I do personally. We see a lot of patients with what's called macromastia, having large breasts, being very symptomatic from shoulder and neck pain, moisture and rashes under the breasts, requiring medications, infections, yeast infections, inability to participate in activities, playing with their children or exercising, running. I mean, that does affect quality of life. These patients are also, they've sought chiropractic help, massage therapy, acupuncture, physical therapy, and they're all temporizing modalities for the most part. And so I think insurance companies are willing to cover these procedures because of the long-term, decrease with infections, requiring medications for muscle spasm or muscle relaxants, pain medication potentially. And also all the chiropractic PT appointments that these patients are also seeking. So I think it's cost benefit to insurance companies to cover these procedures

Eva Sheie (01:39):
When insurance covers a breast reduction, there's some misconceptions out there about what you are required to do in order to get a breast reduction covered, and I don't think it's true anymore. And I think the question I'm asking is are you still able to get a beautiful aesthetic result even when insurance puts requirements on you for what you're supposed to do to get it covered?

Dr. Baltrusch (01:59):
Yeah, certainly. So things that insurance looks for, certainly symptoms and kind of things that patients have done to alleviate those symptoms. But yes, there is something that is called a schur scale. And this can be very dependent on the insurance company, but it looks at a patient's body mass index or body surface area. And then there is this scale of how much tissue that should be resected from each breast for the insurance company to consider it warranted or indicated. And most of the time, patients that are coming into our office seeking breast reductions or meet those minimums pretty easily. And occasionally we have patients who are still actively trying to lose weight and that only lowers their body surface area and makes it more likely that insurance would cover that under that number. That on that scale is really more of a breast lift or a small reduction. So that is, I would say, a little bit more cosmetic, but certainly regardless if it's a small reduction or a large reduction, very similar techniques. And I would say that the results are still very cosmetic.

Eva Sheie (03:02):
On this podcast, we bring you directly to the doctors who are where before meets after Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.