Breat Reduction Claim Letter

  • breast.idea.ever
  • 2 years ago

I am attempting to begin a claim for a medically nessesary breast reduction from my insurence and I would like to include an extremely well written letter outlining the issue. I know how picky insurence can be so I really would like to put my all in this, as a student I cannot afford it, but it is so incredibly nessesary I get this procedure. Could I get some help with my letter please

Comments (2)

Below is a copy of a letter I found online before I got my breast reduction. I didn't have to file a letter with my insurance company, but wanted to have something ready in case I needed to file an appeal. I was going to change some parts to fit my needs/situation. Hope this helps, or at leasts gives you a starting point.

To Whom It May Concern:
I am in dire need of Breast Reduction Surgery. I endure extreme pain due to my abnormally oversized breasts. My breasts are so large that it is difficult for me to participate in everyday activities. Bilateral reduction mammoplasty is medically necessary in my case, for several reasons.
I have chronic pain in my neck, shoulders, upper and mid-back. Throughout the years this heavy weight has caused my shoulders and upper back to curve forward, leading to misalignment throughout my spinal column. Diagnosed with Sciatica, I am currently taking prescription Ibuprofen for my constant pain. Every time my leg goes numb and I lose all feeling, I worry about the long-term damage to my nerves. I also feel uncomfortable about continued use of prescription painkillers and the affects of non-steroidal, anti-inflammatories on liver tissue.
In addition to this lower back condition, I also suffer from pain in my middle and upper back, shoulders, neck, and arms. At times, I can feel nerves being pinched in my upper back and neck area, and jolts of pain will radiate down my upper extremities. The weight of my breasts is a strain on all these areas, and the pains are increasing steadily. My back crackles and pops each time I try to straighten out my hunched forward shoulders.
I am frightened about the obvious and continued misalignment of my spine, and I worry about suffering permanent damage. I am desperately trying to lose weight to relieve this debilitating pain, and avoid future back surgery. Unfortunately, my breast size greatly interferes with my ability to exercise.
It would be much easier to achieve my weight loss and fitness goals, if I were able to exercise freely, and without pain. I have always had trouble breathing properly while exercising. Even as a young teenager, my family doctor admitted that the extra weight on my chest would always make it harder for me to breathe.
I am enrolled in a weight resistance program at the fitness center I joined. The Chest machine, a basic piece of nautilus equipment designed to strengthen pectoral muscles, is difficult for me to use correctly. My abnormally large bust makes it impossible to fully complete the range of motion, which contracts the targeted pectoral muscles. This is very frustrating, since it is the best way to build chest muscle support for the load I carry.
Horseback riding is one of my greatest loves, but it wrecks havoc on my body. The jostling causes my breasts to flop around, despite my best attempts to secure them with supportive attire. There are several other sports I would love to try, but I find it nearly impossible to move freely and without embarrassment since I cannot control the bouncing of my massive breast tissue.
My bra has ultimately become an instrument of pain as the bra straps cut into my shoulders. I have permanent grooves in my shoulders where the bra straps have exerted their pull. I will always have these scars as the bone has been permanently molded. A reduction will not make this go away. But it will lessen the pull, and cause less pain and disfigurement in the future.
Even with the best of bra support, there is still some overlap and contact between my breast skin and my lower chest wall skin. Especially in the summer, I always have a chronic skin irritation. During exercising, it becomes very sweaty, and irritated, due to moisture accumulation and chafing.
Another factor in my decision to seek a breast reduction is the fact that breast cancer runs in my family. My aunt and two maternal great aunts, all had breast cancer. It is virtually impossible for me to do an accurate self-examination, as my large breasts are very dense. I understand that early detection is my best weapon against breast cancer, but I may not be able to detect something that is located in an area that I cannot feel. I am very concerned about my inability to conduct a breast self-examination successfully.
Although I have not yet experienced a mammogram, but I understand it is a much more painful procedure with large breasts than with smaller ones. And a mammogram may not give an accurate reading either, as the breast tissue is very thick and it is difficult to see through.
I am quite self-conscious about my breast size. I know this is not something that is normally evaluated. However, I want you to know how I feel as a whole. I have suffered a variety of unwanted attention for many years. It is hard to find clothes that fit around the bust, and increasingly difficult to locate bras. I wear a size 40 I.
Even after losing nearly 35 pounds, my bra cup size has not decreased. In fact, if I could actually find a bra with a larger cup size, I would order one. I don't fit neatly into my current bra cup size. I constantly need to readjust my bra, so that my breasts are not bulging out in front and showing a big ridge. I do this "shifting" of my breasts in the bathroom, or in my office at least 10-12 times each day. I always wear two bras in order to support the weight of my breasts. I never undress in front of anyone, not even my sisters, because of the humiliation of having to wear two bras, one on top of the other.
Thank you for taking the time to read my letter. I wanted to express my concerns and outline the reasons why I need this procedure. It is my goal to be healthy and active. I believe with this surgery, I can finally reach that goal.
Due to the extreme abnormality of my breast size, breast reduction surgery is most definitely medically necessary. Please review the enclosed letters of support from my Primary Care Physician, and Plastic & Reconstructive Surgeon.
I hope you will reconsider this important decision.
 Original Letter requesting authorization (11/5/XX, Doctor's Name, MD)
 Denial of Authorization
 Letter of support from PCP (Doctor's Name, MD)
 Letter of support from Plastic Surgeon (Doctor's Name, MD)
This letter is excellent, and I will surely be using it as a guide wire so to speak if I end up having to go into the appeals process....