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sgramm 05-12-2008 05:24 PM

Breast reduction insurance questions
I am a 40+ Mom who has larger breasts 36DDD. I'm 5'2", around 160# and have back problems. I started my journey for breast reduction in 2005. I went to a plastic surgeon who told me I was a "prime" candidate for reduction. I have had back and neck pain for years and wanted to get his opinion. I then went to my family doctor who confirmed that indeed I have scoliosis. I was referred to a physical therapist. After 12 visits, I was in worse shape than when I began. I turned all the information into my insurance company and was denied. 3 years later I'm in the same boat. Back problems that hinder everyday activities like just emptying the dishwasher and normal yardwork. My husband has the same insurance company that he had then. I would like some advise as to the steps I should start with this time. I'm determined to have a reduction! Please help me make the right choices to achieve my goal. Thanks! S

Mel52 05-12-2008 08:55 PM

Re: Breast reduction insurance questions
appeal their decision. The insurance companies expect you to give up. Years ago I had a ruptured breast implant removed. The tissue of my breast had to be removed. Silicone and all the other chemicals had spread to the center of my chest and I would have been left with a mess without reconstruction and a lift. My neighbor, as a nurse, was on a committee to review claims. She told me I would never get approval since it was an elective surgery. She said approximately 90% of people do not appeal. I wrote a letter to Blue Cross. I explained I had originally been told implants were safe and would last forever or I would have never indulged in them. When I started getting sick, Blue Cross doctors told me there was nothing wrong, so I continued to live with the implants getting more and more sick. When doctors finally said there was something wrong and I needed the implants removed, It was denied. I had several doctor reports submitted and again I was approved for the surgery but denied the reconstruction. I then wrote a letter. I also picked a surgeon outside of Blue Cross and was asking them to allow me to have him do the surgery. I went through my insurance book and read everything I could find. At that point I found that if a speciality surgeon was not within 50 miles of my home I could go outside the system. The surgeon was a microvascular surgeon and we certainly didn't have one around here. I also wrote the doctors here who would take out the implants were the same ones who told me years before there was nothing wrong with me. I asked why would I want to entrust them with my care? I also said they were small town doctors whose fees were actually higher than the specialy surgeon I had picked at UCLA and he was the chief of staff.
It was worth the fight. Shortly afterward, Blue Cross changed their policy and became much more lenient. The whole point of this is to not give up. Apeal, write letters, see if you can find law cases on previous lawsuits, use the internet to find studies or articles that enforce the truth that the surgery will benefit your back and shoulders. Print it out and enclose it. Perhaps the doctor's office has pamphlets you can enclose with your letter to the insurance company. Explain the daily pain you are in, how your back aches and over time as your body breaks down from the excess weight, you will be costing the insurance company alot more money, blah blah. They know all this. I know women who have had the surgery done through their insurance company without being jerked around. I thought it was easily approved. Your company sounds like they are jerking you around alot. Take a deep breath and go back and fight. Good luck! They turn you down, turn around and go back in.

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