TexasWildRose04
02-22-2005, 02:19 AM
Hey All...I usually post on the back problem boards... but thought I might post here and maybe ya'll can give me some insite on what I might try..... I was feeling pretty good and on top of the world until this afternoon.... I had gone on the referral of my Neuro, to a Plastic Surgeon to see if I could get a breast reduction to help my back problems....last week I got the letter saying my insurance approved it.... The line between comestic and medically nessecary is removing 400 grams per breast... I was having 800 grams per breast removed... nearly 2 lbs. per breast... going from a DD down to a C cup.......Well, they set up the surgery date and I was to go on March 3 for a Pre-OP appointment with my plastic surgeon, then my reduction surgery was scheduled for March 9....Well, the billing department clerk called me this afternoon and proceeded to tell me that my insurance would pay 80% .. I am responsible for 20%... and I have a deductable that I have to meet because since it is a new year I haven't met mine for this year so far.. so she proceeds to tell me that I will need $968.00 and some change on March 3 when I come for my appointment...because the doctor requires it up front... I ask If I could make payments or something and she basically said... NO! he requires it upfront.... so I told her well, guess I won't be having the surgery right now then... so she says... "well when do you think you will have the money?" " I basically said... its not like I have nearly $1000 laying around, I am waiting for my disability to make a decision because of my back problems, nerve damage... blah blah blah.... and I am not working right now... so I dont forsee it anytime soon....so she basically says... well, just let us know when you get the money....and hung up.... I must say, I am quite depressed, I so badly wanted to get this done, to possibly help relieve my lower and upper back and neck pain... along with this they said it would help my constant migraines....someone had suggest that I talk to the doctor himself about maybe working something out...or talk to his assistant.... Oh well, when it rains it pours... Sorry, just had to vent a bit...but any input or suggestions are more then welcome...
Yall, Take Care.
Yall, Take Care.
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preciousink
02-27-2005, 07:14 PM
Sorry to hear about your issue. I am some what having the same issue. I am trying to have the operation and i have to wait to see if my insurance will cover it. I have bad headaches days at a time but they say i am overweight and I may be denied. I have back pains but my headaches are worst so I don't complaint as much. I had to get my doctor to write a letter for me and he act like he didn't want to and he made me seem like I am insane just because I have hugh breast. Just for what they wrote in the letter they may send me to counseling before I have it (if they allow me too). Hugh breast run in my family. I can't afford to have the surgery on my own and I did one smart thing I did the Health Spending Account which was a little extra money out of every check so that they can pay for the surgery. I just hope mine will pay for 100% or atleast 95% i now that is too much to ask for.
I wish you all the luck in the world. I need it myself.
I wish you all the luck in the world. I need it myself.
wlm
03-01-2005, 12:08 AM
I had a breast reduction in 2000. To get it approved through insurance, I had to change from a HMO to a PPO. The HMO kept telling me I was over weight and to just go on a diet. No matter how much I explained that even when I am below my target weight, my breasts did not change that much. The PPO approved the surgery much faster. Unfortunately, The surgeon that was approved had a terrible bedside manner, his office staff was mostly rude and I was never very comfortable with him or them. I was so afraid that if I challenged the Dr that the insurance approved, the insurance would then deny the surgery so I stayed with him. IN the end, he showed up 2 1/2 hrs late for surgery, he never discussed anything as far as how much he was planning on removing or what I should expect. When I questioned him, his response to me - ON THE MORNING OF THE SURGERY- was "DO you want this or not? I am not going to waste my time if you are never going to be happy!" I was SHOCKED but I went ahead anyway. BIG MISTAKE! Although medically, I am happier with the reduction, I am very self conscious of how they look. He placed my nipples freakishly high so a bathing suit is practically out of the question unless it is a halter style. My nipples almost always peek out the top of my bras. My scarring is terrible and I have absolutely NO feeling on the whole underside of my breasts.
I am telling you this NOT to scare you but to let you know that any surgeon who is so callous about the funds and is not willing to work with you- may not be the best to do your surgery. Don't be depressed...this may have been a blessing in disguise. Can you check with your insurance for other doctors who they will approve? and consult with other surgeons in yoru approved network.Give it a try. Many of them will work with you and be much less rude. Sometimes, especially if you explain your current situation, the surgeon will accept the insurance amount as payment in full.
I hope it all works out for you. But please, above all, don't let the surgeon or his staff intimidate you! It is your body- you be in charge!
I am telling you this NOT to scare you but to let you know that any surgeon who is so callous about the funds and is not willing to work with you- may not be the best to do your surgery. Don't be depressed...this may have been a blessing in disguise. Can you check with your insurance for other doctors who they will approve? and consult with other surgeons in yoru approved network.Give it a try. Many of them will work with you and be much less rude. Sometimes, especially if you explain your current situation, the surgeon will accept the insurance amount as payment in full.
I hope it all works out for you. But please, above all, don't let the surgeon or his staff intimidate you! It is your body- you be in charge!
comeonnow
03-01-2005, 10:44 PM
One good thing is that your breast reduction is considered medically necessary and covered by insurance. I'm sorry to hear that the insurance won't cover it all though. I guess I was lucky that my husband must have really good insurance, as my breast reduction was entirely paid for by the insurance through his work. I can imagine how disappointing it is/was for you to find out that yours won't cover the entire cost. I think I would continue looking for plastic surgeons and find one who is at least more sympathetic. I don't know if they are all so into the money, but it just didn't sound like the girl in the office of the one you were too was very sympathetic towards you. I know they don't want to give their services away for free, but I'm hoping that there are still some out there that would at least make some kind of a deal with you. It would be nice if one would accept the portion that the insurance will pay and then let you pay the rest over a reasonable amount of time. Perhaps you would want to talk to your regular family doctor about this and explain your situation to him and maybe he would know of someone who he could refer you to? I sure would keep looking around and wouldn't settle for the one who you were to. Even if it means having it done out of your area where you live, I think it would be worth it. I was fortunate enough that the one who did mine was reasonably priced at $5000 and is only half an hour's drive from my house. I know what it's like to have huge breasts and to want to have ones that you can be happy with, and I hope that you keep trying to find a way to make this happen.
TexasWildRose04
03-28-2005, 04:53 PM
Just wanted to post a reply and let you all know, I go in this Wed, March 30 for my breast reduction surgery....I talked to the doctor and he was willing to work with me on the amount I needed out of pocket... only reason I have to pay anything out of pocket for this surgery is because I had not met my deductable for this year which is $450.... I had met it last year.... just my luck....anyway all worked out... and Wed, 9am I go into surgery.... I am excited.... Thanks for all your replies...
preciousink
03-31-2005, 10:12 PM
Good Luck on your surgery I hope all went well. I am still waiting for my approval/disapproval but glad someone was able to get what they want and need. I hope approval come soon. I wanted it done before i went on vacation in Septemeber but what can i do. How long did it take to hear anything from your insurance company?
TexasWildRose04
04-01-2005, 07:36 PM
Good Luck on your surgery I hope all went well. I am still waiting for my approval/disapproval but glad someone was able to get what they want and need. I hope approval come soon. I wanted it done before i went on vacation in Septemeber but what can i do. How long did it take to hear anything from your insurance company?
It only took about a month for me to hear back from my insurance with approval, they never questioned my need for the surgery or anything...my Plastic Surgeon says I should be recovered in about 6 weeks...Good Luck getting your apporval...
Take Care.
It only took about a month for me to hear back from my insurance with approval, they never questioned my need for the surgery or anything...my Plastic Surgeon says I should be recovered in about 6 weeks...Good Luck getting your apporval...
Take Care.