For women, one of their top concerns when looking towards Breast Reduction is the pain that is associated with this condition.

Breast reduction is very important to women and for Dr. Jacobsen as well. For Dr. Jacobsen, this means taking care of those needing help alleviating back, neck, and shoulder pains that come from the grooving of their brassiere.

It can be challenging to get coverage from your insurance carrier. The criteria are strict and challenging to meet. Less than 10% of women obtain approval. Of those that are approved, many find that after the operation, the service is denied by their insurer, leaving you with a bill for surgery.

Dr. Jacobsen has been for years advocating for women to be approved by their insurers, but the process has been a disappointing failure for ladies and their families. The process is long and arduous and requires many of your resources and our office resources to battle for your approval.

As a result, Dr. Jacobsen will no longer assist in the approval process. If you can pre-approve and pre-authorize your breast reduction surgery, we will be happy to perform this for you under your insurance. But we no longer provide the exhaustive administrative service to authorize your operation for you.

Self-pay is always an option at our office. Our fees are reasonable and affordable for most.

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Almost all women wish to have their insurance company pay for this.

Most insurance companies make this very difficult and do not wish to pay for this type of service, making it very difficult to be approved and authorized for surgery.

Reading the material below will help yourself a great deal through this process.

But Dr. Jacobsen cannot assist you through this process. You can engage and complete this process long before you see Dr. Jacobsen or another surgeon.

Insurance companies deny greater than 90% breast reduction surgeries. You must work hard and fight for your approval!

But if you wish your surgery to do be done promptly and safely, please consider our reasonable fees, and your surgery will be scheduled for you right away, usually within a week.

Hope to meet you soon! Dr. Jacobsen & Staff

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Common Breast Reduction Misunderstandings

• Patients feel because they are suffering that your insurance company will cover the surgery.
• Patients feel that because their doctor said they needed breast reduction surgery that their insurance company will cover it.
• Patients feel if that if Dr. Jacobsen just words his notes properly the insurance company will cover it.

These are false

By allowing Dr. Jacobsen to take over your care, Dr.  Jacobsen will act as your best advocate. You can be assured that his notes will be very detailed and supportive. However, Dr. Jacobsen’s opinion alone is not final. The insurance company’s decision may rely ENTIRELY upon supportive documentation from other supporting providers. By meeting the criteria and having all the appropriate documentation on your behalf will allow for the greatest chance to be approved and covered by your insurance. These can be located by speaking with your insurance company.

Every insurance carrier is different and has a different process.

Steps to Finding Insurance Criteria

• Call your carrier and find the criteria they have for breast reduction surgery in your policy.
• Call your carrier and get a copy of your policy.
• Printout the criteria for breast reduction surgery.
• Document how you meet each criterion your insurance carrier has listed

If you contact your insurance, it is essential to tell and let your representative know that this breast reduction surgery is necessary to your health and well-being. They should be able to give you the exact criteria they use to approve breast reduction surgery.

By obtaining medical records, you can help yourself with the most important part of the approval process; Supporting documentation of problems relating to the size of your breasts and the wish to resolve this by having breast reduction surgery.

Dr. Jacobsen’s staff will not obtain these records for you.  If you wish to have your insurance company approve your surgery, you must obtain the records, email and/or fax them to us

Once you meet the criteria you cannot be denied for surgery! If you want your surgery work on this diligently.

List of Medical Records Needed for Approval:

You can send these to Dr. Jacobsen’s office

• Primary care physician
• Referring physician
• Back or spine physician
• Physical therapist
• Records from any other non-surgical physicians

You can be your own best advocate by physically getting your own records. You must go to your doctor’s office and request these records and bring them to our office.

Records can be faxed to 602279.1701 or emailed to emaildrj.com.

The best method is sending your records on your own behalf, oftentimes by calling other offices and asking them to fax your information usually fails. As offices can be extremely busy and sending records becomes of low priority when dealing with higher risk patients. We receive all faxes electronically, so we do not miss any faxes. We recommend going to your doctor’s office to obtain copies and bringing them at time of appointment. We will not call your doctor’s office to retrieve documentation. Once we receive your documentation, we will be happy to submit them to the insurance companies on your behalf. We cannot be your administrative assistant. If you wish your surgery to be approved you must obtain your records on your own.

Call your carrier during the approval process:

• They can help give you the status of your approval or denial.
• Insist that they tell you why you are not approved.
• Insist that they tell you specifically what criteria you have not met.
• Do not believe them when they say you are denied because Dr. Jacobsen did not do the authorization properly.

Be Aware of Carrier’s excuses

Insurance companies will often tell patients that they are not approved by fault of the practitioner, and they are the cause of your denial. To avoid this, make your carrier explain to you what criteria you do not meet exactly!

Be assured once we receive records we have done everything properly and timely. Our office handles the insurance authorization process daily, quickly with no problems and knows exactly how to do it. Before taking any complaints to the office make sure of the denials you are receiving from the insurance carrier. Authorizations are based solely on the criteria you receive from your insurance company.

If your surgery is still denied by your insurance company, we will be happy to work with you. Attached is an Estimated Cost for Surgery for your information.  After a consultation, we will prepare a more accurate personalized Financial Commitment for Surgery for you.

At any time during this process, you can contact our office for an update on status or to answer any questions you may have at emaildrj.com.

And remember . . .  You must work hard and fight for your approval!

Fax: 602.279.1701

Email: [email protected]