Aetna breast reduction form. I just had my Aetna-approved breast reduction two weeks ago wit...
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Aetna breast reduction form. I just had my Aetna-approved breast reduction two weeks ago with an out-of-network surgeon! Things you can do now, even before seeing your new PCP: get massages (I got a Massage Envy membership and put "back pain" as my reason for every visit on all the forms) or start visiting an acupuncturist. This form will help you supply the right information with your precertification request. . Nov 24, 2025 · To apply for Aetna coverage for a breast reduction, you (and your provider) will need to submit detailed documentation, including: High-quality photographs (front and side views) that clearly show breast size and shape. Introduction Aetna plans exclude coverage of cosmetic surgery and procedures that are not medically necessary, but generally provide coverage when the surgery or procedure is needed to improve the functioning of a body part or otherwise medically necessary even if the surgery or procedure also For all other members, we encourage you to review Clinical Policy Bulletin #17: Breast Reduction Surgery and Gynecomastia Surgery, before you complete this form. The type of reconstruction performed depends on body type, age, general health status, type of cancer treatment Oct 18, 2024 · Healthcare insurance may cover the costs of breast reduction surgery. For all other members, we encourage you to review Clinical Policy Bulletin #17: Breast Reduction Surgery and Gynecomastia Surgery, before you complete this form. Failure to complete this form and submit all medical records we are requesting may result in the delay of review or denial of coverage. 3 days ago · Insurance can cover a second breast reduction, but approval depends on documenting ongoing symptoms and meeting medical necessity criteria. Member name: Page 1 of 4 GR-68829-2 (5-18) PCFX Breast Reduction Surgery Precertification Information Request Form Applies to: Aetna plans . Typed responses are preferred. The surgeon forms a breast mound by using an artificial implant or autologous tissue from the abdomen, back or buttocks. Learn if Aetna covers breast reduction procedures and who is eligible for coverage. This form will help you supply the right information with your precertification request. If you’re struggling with symptoms from large breasts and have Aetna insurance, the best way to determine your eligibility is through a formal consultation. For a breast reduction surgery to be covered by Aetna PPO insurance, patients must have large breasts that are causing symptoms neck and back pain and shoulder discomfort. Moved Permanently To schedule a consult with Dr. Health benefits and health insurance plans offered, underwritten and/or Policy Scope of Policy This Clinical Policy Bulletin addresses cosmetic surgery and procedures. Applications and forms for health care professionals in the Aetna network and their patients can be found here. Innovation Health® plans . Background Breast reconstruction surgery rebuilds a breast's shape after a mastectomy. Apr 15, 2025 · Our office team is experienced in working with Aetna and other insurance providers for breast reduction pre-authorization. See our precertification lists or utilize our CPT code lookup to see whether a procedure or service requires prior approval. Browse through our extensive list of forms and find the right one for your needs. Page 1 of 4 GR-68829-2 (5-18) PCFX Breast Reduction Surgery Precertification Information Request Form Applies to: Aetna plans . Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Health benefits and health insurance plans offered, underwritten and/or Breast Reduction and/or Reconstructive Surgery Precertification Information Request Form Section 1: Provide the following general information If submitting request electronically, complete member name, ID and reference number only. g. Medical therapy should be aimed at correcting any reversible causes (e. Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. Hirsch, please call the office at 818-825-8131 or fill out our contact form. Discover the Aetna difference. Innovation Health® plans . , drug discontinuance). Effective May 23, 2018, this form replaces all other breast reduction surgery precertification information request documents and forms. Implants are silicone sacs filled with saline (salt water) or silicone gel.
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