Insurance and your BR

  • shouldasooner
  • San Diego, CA
  • 2 years ago

Ok, so this is interesting and may help people in the future. I tried to get insurance to pay for my BR. I was rejected because I did not have documentation of back pain. If you need insurance to pay, start complaining and go to physical therapy or chiropractor. I didn't do any of that, so I resigned myself to paying for my surgery.  Surprisingly, insurance did pay for my anesthesia and my meds.. BUT, they did not pay for my lab work. When you have a BR, all the stuff they remove is sent to the lab, to check for cancer cells. Now, this I do not think of as cosmetic, so I really think they SHOULD pay for that part, but no. Cost about $400. Another surprise was that I was able to use my flexible spending account for my surgery even tho insurance rejected it. I believe it was due to the way my PS's office billed it....medically necessary, not cosmetic.  Isn't insurance fun??? Signing off, hope this info helps someone.  

Comments (8)

Has anyone ever heard of Medicaid covering a BR? I had insurance for years at work and could never get a BR approved. Then after having shoulder surgery due to a injury at work and being told I could not return to my job field. I had to go on Medicaid and found a Doctor that took Medicaid for a BR.. WOW i thought after years of trying to get my insurance to cover it. And then my Doctor tells me that Medicaid does not require Pre-Approval !!! I had my BR on March 21...
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I was denied coverage my first time around. I appealed, got a letter from a chiro i saw a few times and my fam practice dr. It went right through the 2nd time. 38F-38C. Its awesome and worth the fight!
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Hi ladies, I started seeing a PT back in 2009-2010, haven't gone back since I lost weight I thought the paint would go away 30lbs lighter and smaller back strap later I'm trying to get it approved. Thank Goodness I have a PS that fights the good fight for patients who need medically necessary BR. I just hoping its enough. I'm 4'11" 134 lbs and I wear a 34ddd my PS said she'd take out about 250-300 cc's making me a full C. So let's see where this leads me. Good luck to all of my big boobie cyber sisters. We pay a great deal of money for INS and they'll make you jump through hoop after hoop in order to DENY you. Fight back with appeals and hopefully it'll go through!
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Hi! I'm 37 years old, but have had problems since pregnancy/breastfeeding 10 years ago. I just found out today that my insurance will need more documentation. :( They want 1-3 months of PCP visits that document back/shoulder pain, rashes, etc. So it looks like I'll be making some appointments for awhile. *sigh*
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Maybe your insurance won't have the same guidelines and you will be approved. (best case scenario).
Don't know how old you are, but I should have done mine 15-20 years earlier.I think not wanting to spend the money was an excuse I used to myself to rationalize not going out and just doing it. Big regret.
I hope your insurance comes through for you…..keep us posted!!!
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Ugh...I'm currently awaiting insurance and I'm worried they will deny since I don't have documented pain, chiropractic care, etc. We all know that does not help the cause of discomfort and pain! I'm currently a 34ddd, and in great shape. I've reached the end of my rope. I don't feel I could wait a whole year. :(
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The first time I applied for insurance coverage, I was denied for the same reason (no medical documentation for back/neck pain.) So I looked up my policy guidelines, (which is great for insomnia, by the way,) and found it said I had to have at least 12 months of documentation. So for over a year I got physical therapy, went to my doctor several times, and had a physiatrist (which is a pain management specialist) write up a statement. I then resubmitted my request and was approved. Sometimes you just have to be patient. I found the year wait to be well worth it! If you're thinking about the surgery, it pays to start getting documentation now.
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This is great information. Thank you!

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