How do I even start this whole process?

  • WhoDaThunkIt
  • kansas
  • 3 years ago

I have years of documented pain in my neck, back and shoulders, and my current pain dr is WONDERFUL. I've been horribly, embarrassingly huge since middle school. I wanted to wait for the surgery because I didn't want to risk not being able to nurse, but I'm done having babies, and I'm 42, and it's past time to start. Another member on this site has referred me to a couple of drs who have good reviews online. So. How exactly do I start this ball rolling? Do I call the insurance company first? Do I go to the b.r.dr first? What do I do? Also, if anyone has info on how long it took from first apt or phone call, to the actual date of the surgery, could you let me know? I'm trying to figure out the timing of all this; I'd like to have it in the summer before I turn back into the human taxi during the school year. Thanks all!

Comments (12)

Sort by

Oh, never mind, i just looked up your profile thing, and saw that you're scheduled for June surgery. Happy Day! You must be stoked.
  • Reply
I am, indeed, stoked. As the date approaches I find myself obsessing a bit about the recovery and the gross bits, like wound care. I'm trying not to think too much about stuff like that and instead focus on all the shirts and dresses I'll finally get to wear. For the first time in my life, I'll be able to buy a dress in my actual size (6), instead of my chest-accommodating size (12 or 14).
  • Reply
Oh my word, that's really fast! You must be so happy about that. I have a fear of it dragging on and on. I'm in this odd place where now that I've decided that this is really going to happen, I want it to happen RIGHT NOW. Like a four year old. I didn't realize that stuff like the dents from bras and the bad posture helped a case move along. I have that, too. I have horrible posture in fact. I also have a dowagers hump, like I'm one hundred years old. I hate it. I'm hoping it will go away after the surgery, but I'm not holding my breath on that.

Have you had your surgery yet? Btw thanks very much for your response, I appreciate it.
  • Reply
Hi salt water! I told my primary care doctor that I'd like a plastic surgery consultation for breast reduction, and she had been treating me for daily headaches. She wrote in my chart that my headaches were due to a breast disorder, and that went in the referral to the plastic surgeon. I was able to see my PS within two weeks of her referral.

During my initial consultation, the PS asked me about my back and neck pain and my headaches. I had physical therapy for six months a couple years ago, so that helped document the back pain issue. He took pictures to document the amount of shoulder indentation, ptosis (drooping), and body proportion issues. He told me I was an excellent candidate to have my BR covered by insurance. He took measurements of each breast to help document his recommendations regarding tissue removal, and the paperwork was sent off to my insurance carrier--Western Health Advantage.

From the time the paperwork was submitted to approval was about a month, and I was eligible to schedule right away. So the total timeline from initial consult to surgery for me will be 2 1/2 months, including me off the surgery for a month for scheduling reasons.

I was surprised at how quickly it all goes once you have that initial consultation. It's not that long too wait if you've been contemplating the surgery for years. Best of luck to you.
  • Reply
Bonnie is right! Just depends on the ins. co. If they think they are going to have to pay more in the long run with additional therapies/etc, they may go ahead and approve the surgery.
  • Reply
I made an appointment with my PCP, who referred me to a surgeon. He put the request in to my insurance co, which turned me down the first time because I didn't have at least 12 months documentation that 1) I had physical problems stemming from breast size, and 2) I had tried 'conservative means' to treat them first. So for a year I had to jump through hoops (physical therapy, documentation of pain medicine use, etc.) One of the best things I did was to see a physiatrist (pain management specialist) who wrote a letter stating that therapy was not working and without the surgery my condition would only deteriorate and require more complicated (read: expensive) means to manage. After a year I went back to my PCP, who referred me back to the surgeon, who submitted all the documentation and physiatrist's letter to the company. Lo and behold, this time they approved the surgery.

You have documentation, however, so hopefully your process will be less of a headache than mine.
  • Reply
Best of luck! With your documentation - you should be good - just depends on your ins company. I already had a plastic surgeon in mind - but that is who did the majority of the pre-auth process with the insurance company. They did require me to get records and a letter from my primary care physician that stated the neck/shoulder/back/rash/shoulder notching pain. I was very surprised at how quick my insurance company responded once the letters and pictures were submitted.
  • Reply
Does'nt that just drive you crazy? I never understood why clothing companies don't make tops with breast size in mind. I buy tops too big for me and end up looking like a tent..ugh. Good that you are going to two surgeons, fingers crossed! :-)
  • Reply
Thanks so much for your help, it helps so much! This site is wonderful, isn't it? I've researched b reductions elsewhere on the web, but this is the best place that I've seen anywhere, by far. And, everyone's so supportive here, I can't believe it.

I am going to call my gp for an apt or referral monday, and make apts for the two plastic surgeons that I've kind of sort of decided on, so I can meet them in person. It would be awesome to have my process go as fast as yours has. I'm so tired of having to buy shirts and dresses two sizes larger just to fit my knockers. I get the rashes, like you. They're not fun.
  • Reply
Hi, I think it all depends on the insurance company and the surgeon. I did not have visits to chiropractors or therapists. My back and neck pain was something I thought I had to live with. I had mentioned to my previous primary that I was considering a reduction but it never went anywhere. I finally got sao tired of it and toald my current primary that I wanted to look into it. She set up an appointment with surgeon the following week (in March). The surgeon told me that he didnt think it would be a problem getting coverage (but did say its hit or miss with them) and that it takes around four weeks to find out. I got the call four weeks and 1 day later that I was approved. This was in April and they wanted to set up surgery for May but I couldnt so took a June appt instead.
I could tell just by talking to my PS that he knew how to work with the insurance companies and I think that is important...I really was so nervious because I didnt think I would get approval. It didnt hurt that I had a bad rash when they took the photos! :-) I also had two biopsies last year with benign lumps in my breast so that may have helped my case too. With the years of going to a pain doctor I would think you would have a good chance :-) Good luck and keep us posted!
  • Reply
Thanks for your response!

So when you say your ins needed six months of documentation, what kind of documentation? If I've been going to a pain doc for my neck, shoulders and back for years and years, does that count as documentation?

Should I just find a plastic surgeon first and start there?

  • Reply
My surgery is scheduled for next week! yippeee....excited but nervous. My ins required at least 6 mo of documentation. My first documentation was in Sept 2010 (did not previously have ins) In Feb my PCP referred me to a plastic surgeon. My first appt with the PS was in March. They took pictures and submitted a letter (along with one from my PCP) to my ins. co. Appx 3 weeks after the plastic surgeon requested pre-auth the ins co contacted my plastic surgeons office stating that it appeared to be medically necessary. My surgery is scheduled for May 13th. Hope this helps!
  • Reply