Commonly Asked Questions about Breast Reduction Surgery & Insurance Coverage

Will Insurance Cover my Breast Reduction Surgery?

In order for a breast reduction to be covered by your insurance, the insurance company must deem it to be “medically necessary.” This definition however varies from one insurance company to another and therefore is one of the most challenging procedures to get health insurance companies to cover. Our billing team at Ponte Vedra Plastic Surgery has years of experience navigating this challenge and is available to assist you.

What does Medically Necessary mean?

Most insurance companies require documentation that shows conservative measures have failed to relieve your back pain and discomfort. Conservative measure may include supportive undergarments, over-the-counter creams or medications for rashes, prescription pain medications, and even physical therapy. The most efficient way to assemble this information is to ask your provider, usually a Primary Care Physician, OB/GYN, or chiropractor, for a letter of medical necessity that outlines your symptoms, duration of tried and failed therapies, and his or her recommendation for breast reduction surgery.

What information will I need to provide?

When you call to schedule your consultation, we ask for your insurance information as well as current height and weight. Most insurance companies use a scale, sometimes referred to as the Schnurr scale, which uses your height and weight to determine the amount of breast tissue that needs to be removed for the surgery to be considered medically necessary. We will provide this information to your surgeon before your appointment along with the specific guidelines for your insurance. With that information in hand, your surgeon will perform an examination and be able to determine if sufficient breast tissue can be removed for insurance purposes and whether doing so will render the result you wish to achieve.

How long will it take to get a determination of coverage?

At your consultation we take photographs which we will send as part of a Precertification/Pre-Determination request. Some insurance companies can take 4-6 weeks to complete this review so be patient and know that our team is following your request and dealing with the insurance company on your behalf.

Once your surgery has been approved, you will get a phone call from our team to discuss what your patient responsibility will be. Since we bill for the surgeons and the Ambulatory Surgery Center, this helps to ensure no surprise bills after your surgery.

nicoleAuthored by:  
Nicole Jones, CPC – Revenue Cycle Manager

Exercises That Can Tone Your Arms

Even if the sleeveless weather has passed, it never hurts to have strong, sexy, toned arms. Look great at holiday parties or start preparing for summer weather early with these exercises that will give you sexier arms.

No Equipment Necessary

There are plenty of exercises that can strengthen your arms without requiring you to visit the gym or invest in equipment. The following exercises can be done at home with stuff you have around the house.

  • Planks: Planks strengthen your whole body, and tone your arms. There are many variations of planks, but all of them will help you get better arms. You can do planks with both hands on the mat and your arms straight, you can put your forearms on the mat to change the weight distribution, or you can do side planks where you support your weight with one arm and one leg.
  • Push Ups: Pushups can be done almost anywhere and they also work your entire body. If you need to build strength before doing traditional pushups, do inclined pushups on your stairs or modified pushups with your knees bent on the ground and your feet in the air.
  • Chair Dips: If you’d like to build tone in your triceps, consider chair dips. Make sure the chair is stable and won’t slip. Then scoot to the very front of the chair and support your weight with your hands. Lower yourself until your butt almost touches the ground and then raise yourself back up until you are even with the chair.

Grab Some Dumbbells

If you’d like to invest in a little bit of workout equipment, dumbbells are versatile, affordable, and portable. The following exercises can be done with a pair of dumbbells. Start with two 5-pound dumbbells and increase the amount of weight as you build strength.

Good options include triceps extensions over your head, lateral raises, and bicep curls.

While exercise is a good way to improve tone and build strength, exercise cannot always eliminate extra fat or loose sagging skin on the upper arms. If you need some extra help eliminating the extra flab or saggy skin in this area, consider brachioplasty. This procedure can give your arms a slimmer, more toned look and as an added bonus, your clothing will fit more comfortably and you’ll look younger. Schedule a consultation at Ponte Vedra Plastic Surgery to learn more.


Plastic Surgery Procedure of the Month – The Tummy Tuck

The Tummy Tuck, also known as Abdominoplasty

Abdominoplasty, more commonly referred to as the tummy tuck, is often the procedure of choice for getting the abdomen back in shape after pregnancy, after extreme weight loss and for those whose tummies simply don”t respond to traditional exercise and proper nutrition.

There are two general types of abdominoplasty: the mini tummy tuck and the full tummy tuck.

The mini tummy tuck is generally reserved for those who have minor contour problems and less loose skin, yet still need more correction than liposuction alone can fix. The mini tummy tuck procedure uses a short U-shaped incision which is made just above the pubic region. Excess skin is removed and the muscles are tightened which moves the belly button down slightly.

The more commonly performed full tummy tuck provides much more correction and therefore, more profound results. The procedure, which generally takes between two and five hours under general anesthesia, uses an incision which is made slightly above the pubic area from one hipbone to the other. A second incision is made to free the navel from the surrounding tissue. The skin is separated from the abdominal wall up to the ribs and lifted to expose the muscles. The muscles are tightened and sewn in place. If you have muscle separation, pulling your muscles closer together and suturing them will give a tighter look to your abdomen. The skin is stretched back across the abdomen and extra skin is removed. Your belly button is then repositioned and sutured in place. Finally, all incisions are sutured, dressings applied and temporary tubes may be inserted to drain excess fluids.

Abdominoplasty is frequently performed in combination with liposuction (especially around the sides of the stomach, hips, and thighs) to give additional contouring and enhance your final results.

While there will be permanent scars, they will be well hidden when you”re wearing clothing, and low enough to even be concealed by a swimsuit in most cases. After about nine months to a year, your scars will usually flatten and become less noticeable.

Doctors Rumsey, Burk, Scioscia and Snyder all have extensive experience in performing abdominoplasty surgery and can help you achieve truly amazing results. If you feel this procedure may be right for you, schedule your consultation today. They will take the time to discuss your expectations, and will thoroughly explain precautions, risks versus benefits of the procedure, as well as what to expect before, during and after your tummy tuck.


Tummy tuck in Jacksonville, FL

Image Courtesy of Dr. Burk’s Plastic Surgery Photo Gallery

Tummy tuck in Jacksonville, FL


Tummy tuck in Jacksonville, FL