Breast Reduction by Health Insurance
Breast Reduction by Health Insurance
While some women seek the appliance of silicone to enlarge their breasts, others search for breast reduction . Among the foremost common factors caused by excessive breast size are back pain, problems with posture and even low self-esteem.
To reduce this discomfort and reach a size proportional to the body, it's necessary to perform a reduction mammoplasty, more commonly referred to as breast reduction - a procedure which will be done by the health plan , although it's not included within the list of procedures and events in National Supplementary Health Agency (ANS).
With that in mind, we've prepared this post with all the knowledge you would like before requesting your surgery. Check it out below!
What is reduction mammoplasty?
The reduction mammoplasty may be a surgery during which it's withdrawn excess fat, glandular tissue and skin of the breast until it reaches a size that doesn't cause discomfort to the column, among other difficulties.
Spine problems are more common in women with very large breasts, additionally, this condition can cause headaches, problems with self-esteem, causing depression, and dermatological problems, because of the constant friction of the skin.
Generally, surgery is indicated for ladies over 18 years old, since at that age the breast is fully developed, which guarantees a good more satisfactory result.
How does breast reduction work?
Before performing the procedure, the doctor may order some blood tests and also a mammogram. it's important to follow all guidelines regarding medications, food and other pre-surgical care, to avoid any problems during the operation.
The procedure takes about 2 hours, requires general anaesthesia and therefore the patient is hospitalized for twenty-four hours, being released after this era, if there's no contraindication. Recovery takes about 1 month and you would like to wear a special bra to make sure an honest result.
When does the health plan cover the reduction mammoplasty?
It is important to spotlight that, in Brazil, health plans don't cover cosmetic plastic surgeries, therefore, this procedure must be indicated by the doctor as necessary for the patient's health and not only for aesthetic causes.
Therefore, breast reduction is roofed by the insurance when the dimensions of the breasts is proven to cause problems or increase certain health risks. The responsible physician must indicate the procedure supported a clinical evaluation. this is often the case, for instance, of:
damage to the spine, neck or shoulders;
unevenness within the shoulders due to the load on the bra straps;
skin irritation, more specifically, within the groove below the breast;
any other pathology related to breast volume that worsens or puts the patient's health in danger.
The responsible physician must prepare a report indicating that breast reduction isn't merely a matter of appearance. during this case, the health plan is required, by law, to buy the procedure.
In addition, when reduction mammaplasty is important thanks to traumatic injuries and tumors, like breast cancer , coverage isn't only mandatory as provided for in article 10-A of Law 9,656 / 1998. The procedure is described as "mastoplasty within the opposite breast after reconstruction of the contralateral in cases of traumatic injuries and tumors".
It is worth remembering that it's not necessary to possess any disease thanks to the dimensions of the breasts, just the indication of pain is enough for the health decide to be obliged to hide the procedure. Finally, all kinds of plans, from the foremost basic to the foremost complete, must suits this obligation, no matter the contracted operator.
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How do i do know if my health plan is safe?
To find out if your health plan is safe, you'll ask the corporate that sells the health plan for the license number of the operator and plan within the ANS database.
Go to the ANS website, and access the knowledge and operator evaluations section , there you can:
· Check if the corporate data really exists, so as to avoid scams;
· Know the performance of the health plan operator within the ANS qualification program, avoiding companies that provide bad and inadequate care to the beneficiary;
· The position that the operator occupies within the ranking of insurance companies that receive the foremost complaints from their consumers, so as to avoid future inconveniences.
What to try to to when the plan denies the report?
It is extremely important to concentrate to our rights, especially in these cases, since it's common for the health decide to deny surgery initially - sometimes thanks to lack of data, sometimes thanks to possible fraud.
In general, the operator's justification is that the reduction mammoplasty isn't included within the list of ANS procedures. However, this denial is taken into account abusive by the Court of Justice (TJ). this is often because, when the procedure aims at curing illnesses, without aesthetic purposes, the TJ judges that the operator has no recourse.
Thus, if the health plan denies the surgery, it's necessary to file a lawsuit with an injunction request that needs the operator to release it. additionally to requesting reduction mammoplasty coverage, the beneficiary also can apply for moral damages.
In order for the method to proceed smoothly, it's important to rent a specialized lawyer, who will adopt the acceptable procedures. However, as long because the report features a clinical indication, the operator must not deny the surgery.
How to request this enjoy the health plan?
The first step in ordering surgery is to form a meeting with a doctor who can assess your condition. If you already suffer from back pain , you'll attend an orthopedist, who will means the explanation for the matter. A GP is additionally ready to assess your condition and, if necessary, refer the case to a specialist. nearly always, any doctor can draw up this authorization.
The surgery is aimed toward reducing the dimensions of the breasts, however, wearing an outsized number isn't the sole requirement which will be taken under consideration. Therefore, the doctor makes a balance between height, chest size, weight and body shape. After confirming the necessity, the doctor must issue a report that points out:
health problem;
the possibility of acquiring some pathology;
clinical reasons that led to the present conclusion;
surgery indication.
The clearer and more detailed the report, and therefore the more urgent the necessity for breast reduction - as in cases of impossibility to figure, walk, exercise and perform simple day-to-day activities - the greater the probabilities of achieving agility in your operation .
What should the health plan cover during this procedure?
When obtaining authorization to perform the surgery, the operator must pay for:
hospitalization;
the surgery;
the fees of the chosen professional.
If the surgeon isn't accredited with the health plan , the beneficiary can request reimbursement if it's provided for within the contract - or if the accredited network doesn't offer knowledgeable to supply care. If there's no provision for reimbursement within the health plan contract , the patient can still choose a personal professional who isn't linked to the operator.
In this case, however, the health plan will still need to buy hospitalization, anesthesia and every one other expenses - with the exception of the fees of the chosen professional, who are going to be liable for the patient.
Remembering that, if the doctor points out that the utilization of silicone prostheses is important , as a crucial a part of the treatment, the insurance company cannot oppose the report and can need to buy them. that's why it's so important that medical authorization is rich in details and makes all the patient's needs very clear.
What are the principles regarding the grace period?
It is also interesting to remember of the grace periods if the plan has been recently contracted. When there's no pre-existing disease , the grace period for surgeries is 180 days, as determined by ANS. However, if the reduction mammoplasty has got to be performed on an urgent or emergency basis , the grace period is 24 hours from the date of signing the plan.
Do not forget that, on the opposite hand, the list of mandatory procedures of ANS contains a minimum list of coverage , and lots of health plans have tried to supply extra services or reduce the bureaucracy of care as a differential for his or her beneficiaries.
The request breast reduction needn't be an upscale process, since you recognize all of your rights and confirm that you simply have everything you would like before you get to your request. Thus, no setback can hinder the procedure.
So don't waste any longer time and begin gathering the documents and knowledge you would like to start out the surgery process today. an honest tip is to urge in-tuned with the health plan and determine about the required procedures, leaving no doubts at the eleventh hour.
Now that you've got learned everything about breast reduction surgery, this information can help others, believe it! Share this post together with your friends on your social networks!
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