Insurance and your BR

By shouldasooner on 22 Dec 2011

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)

Charngo 4 Apr 2012

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...

btowell 27 Mar 2012

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!

Double DDs 27 Mar 2012

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!

Beachy74 5 Mar 2012

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*

shouldasooner 28 Feb 2012

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!!!

Beachy74 28 Feb 2012

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. :(

BonnieJJ 27 Dec 2011

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.