Ready to Free My Boobies - Dallas, TX

Im 31 years old..mother of two girls. Ive been...

Im 31 years old..mother of two girls. Ive been dealing with breast pain since ive been in high school. I developed at 12..was a 36dd by my sophmore year (early pregnancy) . When i was 18, i was scheduled for BR but as soon as i was prepped for surgery, i was pulled from the table.

State Medicaid (louisiana) decided not to pay..(mudducks) anyways..years later and im a 42f..200lbs (my breasts weigh more than the rest of my body) im in need of BR!! I cannot exercise due to my breasts being the way..i always end up with pinched nipples when i sleep at night...i have had one consultation where the doc took the photos but u know if u dont have insurance at the time of srrvice..they wont talk much.

Not a good day for me...apparently my insurance...

Not a good day for me...apparently my insurance has an exclusion where it will not pay for BR surgery. They basically lied to me!! Dont use united healthcare!! Im canceling my insurance with them asap!! I need to find another insurance company asap!"

I really feel like just giving up and dealing with...

I really feel like just giving up and dealing with the pain. Everytime i see a success story of a breast reduction on here, tears roll down my eyes. Maybe im one of those not so luck ones who have to suffer with the pain. I cant stand pain (im a big baby) and i hate the way i feel. I read my policy over & over wishing i could make the words change saying that my insurance could pay for the surgery but its something i have to deal with. So tata for now.

So close to getting a breast reduction

Hi everyone. Its been a while since I posted. I found a new pcp who understands me and know the pain I am going through . Since my last update, my breasts have grew to a 48K. Very heavy and painful at times. The pain was so unbearable to the point where I had to voluntarily quit my job because of the medication I took daily for pain. Fast forward, I went to an orthopaedic doctor, but he sent me to have an open and closed MRI which both were failures, so now I was referred to a plastic surgeon by the name of Dr. Duffy and a orthopedic surgeon as well.
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I just realized that you ladies said united healthcare. I just realized that my insurance says golden rule a united healthcare company so of course my policy excludes breast reductions. Duh
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Hey T, I wouldn't give up if I were you, I got approved on 2 different occasions for breast reduction, the first time was through United, but I was younger and didn't feel comfortable at ALL with my surgeon so I cancelled, then years later I got approved when I wasn't working and only had medicaid insurance, but that doctor wanted to remove WAAAAAY too much and I was not liking his or the ladies in his office attitudes, so I dumped him too. NOW, FINALLY I am paying for the procedure out of pocket. I'm not suggesting that you do the same, not at all, because BR is a procedure that insurance can, should and does cover, but for me I just got so fed up with the doctors I was finding and their criteria, so I decided to take matters into my own hands and pay on my own.

Now the other thing is, plenty of women get denied at first, but you have to keep pushing with these insurance companies. Have your doctor type up a letter saying how cumbersome and painful it is to have such large breasts, how you get rashes and your bra straps dig into your shoulders and create dents...I even typed up my own letter and my doctor signed it and I gave it to my plastic surgeon and they submitted it for coverage, it works...don't give up:)
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I just realized that you ladies said united healthcare. I just realized that my insurance says golden rule a united healthcare company so of course my policy excludes breast reductions. Duh
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You can go to myuhc.com and register on their site to view your account, and claim history, u can also view in network physicians and labratorys.
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Im still.trying to learn that website. Have yall had more than one consultation? My policy says it wont pay for the reduction but it will pay for reconstructive surgery like if you was diagnosed with breast cancer.
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I went to 2 consults, but I only asked 1 of the PS to send the info over for pre-approval.. My co pay fpr speciallist visit is 40.00 and I can go to as many as I want as long as I pay my co-pay. My policy covers BR as long as medically necessary.
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I just realized its a fairly new policy & my PS sent over documentation from the 27th of feb & the policy didnt kick in until the fifth.of march so i can see their reason for denial but im wonder how many consults do i need and how to find a PS under UHC? I think u have the policy so long or they will consider it as pre existing. (i went to school for medical billing)
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I've had my policy for about 2 years now. If you go on their website and log in there is an area that says find a doctor and they give you the name and info about the doctors, And they are all separated by specialty.
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I just got them january 1st of this year!
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I think so but they could have told me when i asked them via telephone would i be approved. The rep lied tome so now im not sure what to do as far as getting better insurance.
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@tstarr, If you were told otherwise by a rep, you can have UHC pull the call, because their calls are ALL recorded.. If you know the date that you spoke to the rep and an approximate time they can pull the call. My in law was lied to once about a in-network facility and she complained about a charge she received from the facility and after they pulled the call the insurance paid the bill in full.
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That's true, if she told you it would be covered they should cover it no questions asked. Next time you call speak to someone in charge, explain what you was told and have them pull the call. They are going to get out of it but you have to hold them responsible and put up a fight, I bet they will give in. Going to another insurance company might not solve the problem.
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*they are going to try to get out of paying*
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Ohhhh... Yeah my plan is through my employer, does that make a difference?
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Now I think they are lying to you. Pre existing condition? God forbid we have breasts before we get insurance! What the hell?? You need to talk to someone in a supervisory position. I believe they have nurses on staff that you can talk to as well. There is no way its excluded for you and not for me if we have the same plan.
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Is your plan through your employer? I just got this plan & now im regretting it. Its short term so im wondering what the hell??
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They told me that br was an exclusion in my policy. My PS called to verify my insurance with UHC. They (uhc) said they couldnt do it because it was considered an pre existing condition.
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@Tstarr, That sounds like Bull!! Tell them u need what they are stating in writing, Ask your employer if BR is excluded from your PLAN. WHAT DO THEY MEAN ITS A PRE-Existing condition? R they kidding me?
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I said the same thing @darkandlovely. Im guessing since its a short term insurance BR are automatically not paid by UHC. My PS said that UHC will mail me a denial letter.
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I have no idea, it can be a number of things. I didn't even have a referral from my primary care doctor. I just made an appt with the PS. I was actually shocked because I thought I was gonna have to have letters and everything but it wasn't an issue. If I were you I would call and ask to speak with someone in charge because it is a medically necessary procedure. Ask your PS office what info they sent and did they send pictures. Also find out the amount recomended to be removed, my PS suggested 1200 grams. There are also certain insurance codes they send that may have an impact on the decision. If the insurance company thinks for any reason it is cosmetic, they will deny it. Is your doctor in network? That may also have an impact. I read one person's blog that said the insurance company denied her with one PS and turned right around and approved her with another PS. If I can be approved without a problem there is no reason they should deny you without giving you an explanantion. So before you change insurance companies get as much info as to why you were denied, you might possibly need to look into changing your doctor. Quite frankly some of them care more than others and will have your back when it comes to dealing with the insurance company. Others want to just focus on their cash paying customers because it's less hassle. Can you tell I'm passionate about this? I don't think any woman should have to be in pain everyday. Don't give up, I hope this helps!
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Thats weird. I was telling my husband the same thing. I saw where you were approved. What gives?
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We all have the same exact insurance plan, I was approved without a problem and it only took about three weeks to get a decision from them. If they have debied you, I say call them and start complaining because I know others that have gotten approved through them as well. You might also want to ask the doctor what information he sent because they will want pictures amount removed, etc. Good luck!
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Do you know what requirements are needed for approval? My doc says he can give plenty of photos and documentation to my ins. Company for approval.
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@tstarr I believe that the amount of grams he is removing has to be at least between the 5th and 20th percentile for approval, and that amount is based on your weight and height..if you don't mind u can give me that info and I will check at their website for you.. How many grams did your PS plan to have removed? Have u been through any physical therapy before?
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U should also call UHC and ask them to send you an explanation of Benefits as to why you were denied... Once you have that at hand you can get with your PS about appealing their decision... I hope you appeal and get approved!!
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