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Old 08-03-2004, 02:45 PM   #1
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limited13 HB User
Question health insurance covering breast reduction surgery

I am looking into getting a breast reduction surgery. I have heard from several people in the past that have had this type of surgery that their medical insurance company covered either all or part of the cost. I went to my general doctor to ask him about this and try to get a letter from him for the insurance company, but he said he would not give me a letter because it was too much of a headache for him and at the end the insurance companies do not pay for this kind of surgery because it is considered to be just an aesthetic surgery. I have told him in the past that I get back pains, neck pains, and headaches quite frequently, but even with this, he will not give me the letter of referral for the surgery. I have made an appointment to see another general practitioner, but in the meantime, I wanted to know if anyone has any advice or experiences they could share with me regarding this issue? If anyone has had a breast reduction and gotten it covered through their medical insurance, please let me know what process you went through with your doctor(s) and insurance company (how did you go about contacting the insurance company/what was the procedure, what and how much documentation did they require, and from whom)...and also, if anyone tried to get one covered and was denied. Thanks a bunch!!

Last edited by limited13; 08-03-2004 at 05:26 PM.

 
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Old 08-04-2004, 10:56 AM   #2
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Re: health insurance covering breast reduction surgery

My best friend had hers reduced and it was covered by insurance. She had to meet a certain criteria (ie...size of breasts vs her frame size, discomfort,,,,) You have to prove to the doctor that this is a medical nessisity, and that your health is being affected by it.

 
Old 08-04-2004, 12:58 PM   #3
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Re: health insurance covering breast reduction surgery

ok....I had one and it is a long process.. I mean 6-8 mos., maybe a year...but get your ducks in the row. You want a new Dr. You want to be up front and document you are seeking medical attention for aches and pains... you feel its because of your heavy load on top. Fill the meds he's given you...go back 2 wks tell him they don't work...he'll issue you something stronger, even if you don't take it--get them filled...wait about a month---go back to him check in, tell him meds are helping some, but not enough you are experiencing the pulling and tugging on your neck area, your arms go numb, tingling* ok..follow me???? You do this enough, he will send you in for nerve MRI testing, back when I had it wasn't necessary but I had to see a BACK specialist---and I flat told him off the record, "I am here because I want a reduction and this is what my dr. told me to do...he wrote it up so pretty...he did do tests on me, and complain when you lean you hurt in lower part of your back, when you sit, your left arms go numb, your bra straps dig into the flesh...all are legitimate complaints. Now, if one Dr won't take insurance, move to another--its likely a reason..well, most are getting away from insurance claims...insurance companies have made it harder to be approved and Dr. don't want to hassle with it--who blames them? ya know..!!! And like the above post you must fit in a criteria--how large you are, your body frame, how much can be removed, and removal is a criteria...I had to have 5 lbs off one and 6 off another, yea I know I was huge.. 44DD or larger, I squeezed into unhealthy bras. Research your plastic surgeon...and believe me its important because my insurance refused one Dr. I was so ****ed off--then my Dr. asked how it was going getting it processed with insurance...I told him they denied it--he referred me to another Dr. and my insurance paid it 100%...why???? I say because the 1st Dr I had gone to was known for more problems after surgery with infections, they flat refused me service to her. Its time consuming, you feel like you are complaining...but the insurance company will side with that specialist...and once they've been paying about 6 specialist exams, medications out the butt, well...they pretty much have the evidence a reduction is necessary.

 
Old 08-05-2004, 01:31 PM   #4
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limited13 HB User
Smile Re: health insurance covering breast reduction surgery

Thanks very much for the info ladies!
Oh, also, PeggyHarmon, do you remember how much your surgery did turn out to be? And did you and/or your doctors have to send letters to the insurance company?

 
Old 08-05-2004, 01:59 PM   #5
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Re: health insurance covering breast reduction surgery

My surgery was in 95 and it was about 7,K and it has since gone done since plastic surgery is the "thing" to do now. I believe he submitted it to the insurance, and got it approved.

 
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