Pleading with Bluecross No Hope So Far - Arlington, TX

Hi im a 38ddd.. 26 yrs at 5'4 weigh...

Hi
im a 38ddd.. 26 yrs at 5'4 weigh 190
changed to 2 brasizes in 3 yrs now..very frustrated with the back aches n ha s. Went to my first consultant on 11/12 doc gave me hopes tht i was a perfect cand. So i went hom pschd up nowin chng n relief is comin wootwoot...nway..yesterday gat mail frm insurance sayin tht thy rejected my plea coz its not a med. Neccesity....i just felt lik dying dnt even finish the letter n started sobbing i dint bliv this......i just don kno wat nxt step to take i really nid this so tht i can hv an active n pain free life anyone help me with ur opinions pliz

So i had to get myself together after the...

so i had to get myself together after the devastating letter of rejection from BCBS which is making it hard for me to focus on my finals this week. i called BCBS again, apparently im getting diff opinions from the agents stating its not a medical necessity even if the surg. stated tht im a perfect candidate. called docs office again thy saying the letter thy received states since i fall under an individual policy i wont be covered. k so called BCBS again i FINALLY spoke to someone who understood my situation, she stated tht i hav to be in a group policy like from an employer to even maybe be considered so its not even guaranteed yikes!!!,so the right thing for me at this point is to figure out how this will work if il hav to add my employer or join them i don kno how that goes but im def following up with my employer n BCBS after im done with skul nxt week. IM NOT GIVING UP YET :)
Dallas Plastic Surgeon

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Don't give up, especially if your doctor agrees that you're a good candidate for surgery. It took me 3 attempts over a span of 3 years to finally get an approval. The first time was right around 3 years ago. I even had a letter from the physical therapist to back up the need for reduction as my breast size was affecting shoulders and neck. The approval came back but insurance agreed to pay for just one side. Crazy! A couple of months later, I decided to try to get back into shape. I had let myself go and gotten up to size 10. I had a 34G bra size. I was not always that large. I seemed to get larger after I weaned each of my 2 children. So, I did get back into shape and lost @18 pounds with 6-9 months and lost 4 sizes (well, depending on the style and make of the clothing). I still felt top-heavy though and by that time was wearing a DD. I had one D size bra but all the others were DD and I still spilled over. I tried a year and half ago for insurance approval and this time was flat-out denied. I had a few set-backs during the past 12 months that made me decrease my gym time so I gained back a few pounds and my breasts must have grown back a little, too, because now my shoulder grooves were really bothering me. I'm really not sure what size bra I SHOULD have been wearing. I was still wearing my old DDs or the one D. I finally went back this past August to doctor (this time new doctor, same practice) and prayed that if it was meant to be, then I will get approval for surgery. Even though my friends said I didn't look too large, I felt very uncomfortable, not only physically, but my self-esteem was affected because I felt like my breasts were the first thing people looked at when they saw me. I hate wearing swimsuits. I wore 2 sports bras to work out so the girls woudn't be bouncing all over the place. It took 2 months before I heard back from the doctor. I was beginning to think that the request wasn't even submitted and I was ready to give up when I got the phone call that the surgery was approved. For both sides! I was ecstatic. As nervous as I was about the surgery, I knew it was the right thing for me. The doctor agreed that because I have a small frame, my breasts were too large for me. And they were very dense, making them too heavy for comfort. I don't know how the surgeon got my insurance to finally approve it but he was in full agreement that I an excellent candidate. He truly seemed to want to help me from the very beginning. I can't say enough good about my surgeon and the staff. So, DON'T GIVE UP! Keep trying and get as many supporting letters that you possibly can from chiropractor, physical therapist, etc. Good luck on everything.
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I would appeal. I have anthem and I was approved within less than a week. I was a 40H and had them taken down to a D. I am 6ft about 240lbs.
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thnx ladies for taking ur time to post, really appreciate some of ur stories r giving me hop too. :)
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I would definitely appeal...but first you should clearly understand what the criteria they used to reject you. I have BCBS and I believe my doctor told me that they have a criteria based on weight and height for min. tissue removed. If you don't meet the criteria than you are going to have to document your back pain. Its frustrating but don't give up. I tried several years with Kaiser to get a referral to a plastic surgeon....and they referred me to physical therapy and nutrition counseling. I switched to BCBS and went straight to the PS and had my surgury within 6 weeks. My surgury was May 2011 and I had about 6 lbs of breast tissue removed. I felt the difference immediately. Good luck!!!
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I would see if Kaiser would allow a consult - I was your size and was approved by them in California and Hawaii and it was a $60 co-pay in Honolulu. Good luck - I had blue cross tell me it was a pre-existing condition in 1998 - give me a break - of course they were pre-existing! Had 'em since I was 13!!! Good luck it will work out!
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I'm a 38 E and was denied by Atnea in September. In January my day's company is switching to BCBS. Praying things work you
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Welcome to the community girlie!

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Appeal! I was rejected too at first (and just cried!). I gathered myself enough to ask the insurance company what the appeal process is. My company was very helpful in letting me know just what to do and my surgeon was very cooperative in talking with the staff physician at the insurance company. After talking with the surgeon, they approved me. Please don't give up! There IS hope and insurance companies DO change their minds. Hang in there and keep us posted.
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I totally understand, I'm a 30jj and I was rejected by Aetna...mind you I'm only 5'1 and weigh 130lbs with a very small frame but they said I need more documentation. Wth
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Appeal it and try again. Good Luck.
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I was rejected at first too. Try filing an appeal or getting some more documentation that it will be medically necessary. Good luck!
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