Q and A:
My most important question, I have Aetna insurance. Is a breast reduction, tummy tuck & upper arm reduction covered? In August I will be on Medicare also. I had a gastric bypass two years ago and have a lot of loose hanging skin which is not allowing me to do physical activity.
Dr. Laverson answer:
Great to hear from you Robin, and congratulations on your weight loss!!!
Because of the insurmountable obstacles that third party payers impose upon many surgeons, myself included, our office has eliminated them from the doctor-patient relationship as much as possible.
We don't want to request permission ("pre-authorization") from non-professionals to treat patients, we don't want to be told what procedures we're allowed or not allowed to do, what drugs we can and cannot prescribe, where to do our procedures, what other specialists and providers we must or must not refer to, and how much we'll be paid for our services. Third parties who are paying for care regulate that care, and they do so without any medical license or liability. They are a for-profit business. We're health care professionals. We don't always agree with insurance company profit-based decisions. From a practical standpoint, insurance related paperwork and administrative responsibilities can be overwhelming.
Because I'm accountable to patients for quality and safety, I must maintain some control over the decision making process in evaluation and management. I like discussing with each patient what they believe to be best for them, and being able to implement a patient-desired plan, as you yourself have articulated (breast, tummy tuck, arms). We must deliver the type of results patients want without restrictions and burdens placed upon us by entities who don't know us, who don't know our patients, and who aren't as committed as we are to the best possible result. Insurance companies, in general, commoditize your care. You're a set of numbers to them. Your premium payments are income they try to maximize, but your care is a cost they don't want to incur. Insurance offers baseline standard care at the least cost. The fee that most payers provide for surgical procedures doesn't come close to covering the true cost of each procedure. If multiple procedures are performed, as you're requesting, insurance only pays for the first one. If two sides are done (e.g., breasts, arms), insurance won't pay for the second side. Billers must be paid, office rent, staff, equipment, supplies, insurance, and utilities must be paid to remain in practice. Although you pay your premiums, and you're thus entitled to care, insurance reimbursement to surgeons is so paltry that after all these expenses, surgeons are not being paid for surgery, we're actually paying for the surgery too. The arrangement is very favorable to insurance companies, and I participated in that arrangement for over twenty years. Thinking I was supporting patients, I was merely enriching third party payers, starving myself and my office, and diminishing my own capacity to continue caring for patients.
I believe patients deserve the best I can deliver. Patients are not numbers here, they're respected human beings with hopes, dreams, and each with his or her own unique, valuable, and special identity. High quality is costly Robin. Our goals and the goals of third party payers are irreconcilable.
So, in essence Robin, if you must have these procedures covered by insurance, your next step should be to consult with plastic surgeons within your network, who accept the insurance you have. This in no way means your care will be less, or your result not as good. It just means that for insurance to pay, you must follow their rules. This means to work with their contracted specialists. I am no longer a Medicare participant. As long as you see a board certified plastic surgeon, and you trust that surgeon, your outcome will likely be just fine. You've already done the hardest part, and the most important part, losing your extra weight.
Don't hesitate to contact us if questions.
The Journal of Female Health Sciences: JFH.TD.13.098
SCIENTIFIC ANALYSIS REVEALS MAJOR DIFFERENCES IN
THE BREAST SIZE OF WOMEN IN DIFFERENT COUNTRIES
– U.S. women have a significantly larger mean breast volume than women born in other countries
John D. L. Anderson – Curator of Human Anatomy, New Delhi School of Applied Sciences
Susan C. Chandler – Senior Lecturer, Aesthetic Surgery, Braga Medical School
Megan A. B. Mason – Senior Researcher, Department of Mathematical Statistics, UISS Chennan B. Khan
– Professor, Diagnostic Technology, New Delhi School of Applied Sciences Jennifer E. Lindsay –
Associate Director, ND Garment Ltd
Richard M. Sandler – Professor of Radiology, Camiry University
Liu G. Wong – President Emerita of Atape Institute of Human Anatomy
In recent years the breast size (i.e., bra cup size and bra band size) of women has been studied in a number of national and regional research projects. Most of the studies have been conducted by universities in cooperation with companies within the lingerie industry and other commercial stakeholders. However, the local studies have not been able to provide internationally comparable results regarding the factual breast size (i.e., breast volume or breast tissue volume) in different countries.
Increasing knowledge of the breast size variation of women from different countries is needed as a guideline for example for the product development and targeting of marketing actions of clothing industry and cosmetic surgery providers.
Recently a group of scientists made a thorough international data analysis with statistically reliable results. The breast size data of women born in 108 countries were converted to a comparable format and analyzed. The study analysis defined in a scientific way the average breast size of 28 – 30-year-old women broken down by country of birth. The analysis was based on accurately measured breast tissue volume of the women in the material. In order to facilitate the practical applicability of the study results the outcome of the final analysis was also expressed as bra cup sizes using the EU bra size standard as a reference.
The study analysis revealed that there is a considerable variation in the breast tissue volume, i.e., the factual bra cup size, of women depending on their country of birth.
For example, women born in the U.S.A have by far larger breasts than women in any other country, while women born in Africa and Asia, particularly in the East Asian countries, have the smallest breast volumes.
Surgeons are physicians specializing in evaluation and management of problems treated and/or cured by surgery. Cognitive (thinking) and technical (operating) skills are required. To become a surgeon, I graduated at the top of my four year college class, near the top of my four year medical school class, then apprenticed as a surgical resident days, nights, weekends, and holidays in hospitals around the United States for ten years after medical school. Many subjects are mastered, including a foundation of basic sciences such as anatomy (gross and microscopic), biochemistry, physiology (healthy function of the body), pathology (diseases), microbiology (bacteria, fungi, and viruses), pharmacology (drugs), genetics, neurosciences, psychiatry, etc. During my decade of residency, benchmarks were achieved each year to advance to subsequent higher levels of responsibility and independence. We learned about the surgical specialties, saw thousands of patients, and worked with doctors in every area of medicine. Oral and written examinations administered by the American Board of Surgery and the American Board of Plastic Surgery were passed. Training and exams were rigorous and uncompromising, designed to assess cognition (knowledge, reasoning, and judgment), technical skills, and professional ethics. All are critically important for surgery. In practice for over twenty years, I still qualify annually by reporting continuing medical education and occasionally taking maintenance of certification examinations.
Why does this matter? Because quality outcomes can only be delivered in the context of high ethical, scientific, and technical standards. Treatments we recommend should have the highest possible benefit to risk relationship: The most upside and the least downside. Because everyone is different and unique, a treatment that is beneficial for one person may be a disaster for another. To differentiate among patients what is best for one individual, we surgeons must ask questions, i.e. learn about each patient in consultation. We must examine our patients physically to know their anatomy, to understand which treatments may work best and which may not be indicated. Sometimes, we must check additional blood tests, X-rays, or other studies for more information. All that data is analyzed, options for treatment are considered, discussed with patients, and a mutually agreeable treatment plan developed. Every patient should be approached with this stepwise sequence of gathering and verifying information, analyzing the information, prioritizing possible solutions based on the presentation, finalizing a plan, and only then, implementing treatment.
As an aesthetic plastic surgeon, our office fields constant calls for this peel or that product, the latest lunchtime lift, mini-tuck, or new device, diet, or implant. Usually, callers read about it in a magazine, saw a TV show (“The Doctors”), or saw advertising. Media is a business, and media exposure is bought by business. The end game of business is sales. Sales are not necessarily about what’s best for YOU. Sales are about revenue for the manufacturer, producer, and/or marketer of techniques, devices, products, and services. We implement new information and technology in our treatments, but only as appropriate in the upside to downside calculation for each patient.
Nobody comes to us for surgery, people come for results. We specialize in results, not in procedures. Procedures are only means to an end. Often, there are several possible operations that will achieve slightly different results. Results are the solution to a problem. The problem must be properly analyzed first, and treatment solutions follow. Inquiring about solutions, whether a new product or a new procedure, before understanding and analyzing the problem is backwards.
By all means, ask about new treatments and technologies, we’ll answer your questions. As a layperson, you’re not expected to know science, biotechnology, and the human body. But you DO know, more than anyone else can ever know, what bothers you when you look in the mirror or at a photograph of yourself. You know your problem, and in our office, that’s all you need to know. We’ll discuss the rest, and decide with you which solution is the best.