G to C in Lala Land... - Los Angeles, CA

Hello ladies! My name is Lexi, and I am in the...

Hello ladies! My name is Lexi, and I am in the process of trying to get my insurance to cover a reduction.

I'm 5'3", 130lbs., and a 32F/G depending on the bra. I would really like to go all the way down to a C if possible.

I used to love the twins in my teens and early 20's, but now at 27 they have begun to head south (I guess they are one day hoping to meet up with my bellybutton?) and I have developed terrible neck, back, shoulder and arm pain. I even have a bit of nerve pain in my left shoulder and arm, which is the scariest thing of all because sometimes my hand goes numb :/

I found a surgeon who I adore about a week ago... A bit about him:
-- He listened to everything I said, and consulted with me in his office for a full 40 minutes before even doing the exam. He showed me lots of pictures of his own work, pointing out the flaws and letting me know they can be avoided, fixed, and how often and why things like "bad scars" and partial nipple death occur. No god complex... I loved that he could critique his own work in front of someone else... Plus, his work is literally the best I have ever seen, and now that I see what a high standard he holds it to I understand why!

--We were on exactly the same page about size. When I showed him a picture of my dream proportions (Katherine Heigl) he said he was super relieved that I had picked the perfect size on my own and wasn't hoping to still be too big... which I guess is a common problem in Lala land.

--He didn't try to up sell me. Most of my friends who have had nips and ticks (and out there that is most of my friends) got talked into add ons.... A recent girlfriend had lipo for example, to narrow out her waist so the reduction wouldn't call attention to it. I asked this guy about it and he not only said I didn't need it and explained clearly why, but he said he wasn't interested in doing it. I am a *bit* apple shaped, but he said I would automatically be less apple after the reduction, and it alone would be enough.

-- I felt comfortable with him and his staff. This is a biggie. Since I have mild complexes about my boobs I hate to have them touched. It's odd actually.... I used to love the way they looked, but at the same time it was as if they were constantly being stared at and I developed a very strong aversion to ANYONE actually getting to touch them. This includes my wonderful female gyno, and my loving hubby. It's like they're mine, and I keep them under lock and key as society demands. Anyone else experience this? At any rate, I was actually OK with him touching me, which said a lot.

So, now he has submitted the paperwork to my insurance company, along with a note form my PC doctor. I am a bit annoyed with her (although I have had her for a decade and generally adore her) because when I went to see her for a physical in January and asked her about the back pain she didn't make note of it in my file.

This could be a huge problem because my insurance dictates that you must have had the pain for at least one year to qualify for the surgery. So, while she wrote my note, if they request my charts they will see no notation of it in January. It's an even bigger bummer because I have a break in my studies (I'm a grad student) in early January... It would have worked out perfectly.... We'll see.

Has anyone else gone through this process with BCBS PPO? Had you documented your pain for at least a year? Both primary care and the PS believed it would be a snap since I well exceed the minimum removal requirement for my size (which is 310 per breast), but we will see.... I am wondering how long they take to decide on these claims, and if I do have to appeal how long that process takes...

Ok, that's it for now ladies! Time to go for a run in my three sports bras (sigh) and hope I don't knock myself out :p the gorgeous rainy weather which is so rare here makes the black eye risk well worth it though :p

PS-- The date below is a dream date, not a scheduled on.

PSS-- I may end up posting some photos for you ladies, but with my issues with keeping them under lock and key I'm not quite there yet....

I have BCBS PPO and they would not cover without jumping through all the hoops - though based on the amount of tissue removed I suppose they might have. I actually was a bit relieved when I found out they wouldn't cover because then I could just go ahead and schedule my surgery for whenever, with whatever surgeon I chose. I know I am fortunate though in being able to pay out-of-pocket, which certainly not everyone is able to do. But remember, you pay them a lot of money for your insurance; they work for you. Keep after them and hopefully it will work out for you.
Thanks for the input! Do you remember why they denied you and how long it took? As a grad student I am stuck jumping through their hoops :( I barely make enough for the accessories I will need for the surgery, let alone the surgery its self, lol! I do pay them a TON though. Way more in a year then the cost of the surgery... So I'm going to stick to it. Plus, I technically qualify.... I meet their criteria, it's just about getting the documents together/in a way they will accept....

Welcome to RealSelf and thank you for posting your journey.  This is a big process and requires much planning and detail.  

You have just made it through the most difficult portion of finding a doctor.  Congratulations on that being done.  You are pretty tiny so I think a C would be perfect for you.  You are going to feel amazing when this is all done.  It gives you an uplifted confidence to be rid of the big breasts.

My insurance did pay for mine but did not require any documentation of long time pain and problems.  My doctor said that as long as he removed the required amount all would be covered.  He could tell by looking at me that I had plenty to spare.  

Keep working at this and you will get there.  I will be watching for your posts!


Hi Ladies! Thank you all for the responses.... I...

Hi Ladies! Thank you all for the responses.... I just spoke to the lady at my insurance company and she let me know that once the doctor gets the paperwork in (they haven't received it yet) a decision will be made within 3-5 BUSINESS DAYS!! This is a much quicker turn around then I expected, and gives me hope that even if it is initially denied I may still be able to get an appeal in and get approved before late December/ early Jan.

Fingers crossed! Seems I don't have as much of a wait as I had anticipated.
I have BCBS and I had my approval in about 2 weeks. I was a 34H, 5'1" and 140. I had a bit of documentation from about 5 years prior that we submitted, but I had not been back because I knew what the cause of my pain was and I wasn't interested in taking pain pills so I just lived with it while using Ibuprofen. My plastic surgeon asked me lots of questions and I told him that I was taking Ibuprofen three times a day, had tried massages, and I also took a letter from my primary care doc stating that due to my small frame, my large breasts were causing neck and back pain. I was really worried that I didn't have enough documentation, but that seemed to be enough. I also did take mammogram reports that stated my breast tissue was very dense which could obscure a malignancy.
Good luck! Hope you hear from the insurance soon!
I have blue shield they approved me as long as I had 500 g removed with no documentation just a letter from my ps
Oh thank you for sharing this!! I really hope I have a similar experience.....

Well ladies... My journey may be over for now :( I...

Well ladies... My journey may be over for now :( I just spoke to the lady at the doctor I have my heart set on's office and it looks like it is a no go with my insurance.

I don't really understand it, but basically the deal is that the compensation package is so poor that even though this doctor usually accepts insurance he is not willing to take mine. She pretty much said even if the insurance precerts they won't tell the doctor what they will pay until *after* the surgery, and that is not acceptable to them.

On top of that, I have a 4,000$ deductible.

I am not willing to pick another doctor... So I think I will have to try to scrimp and save for the next few years. Or find another insurance company and wait the year needed for it to no longer be a preexisting condition.... I don't know. Right now I am just really bummed.

So basically insurance says "yes this is medically necessary, but we will only pay for about 30% of it. Oh. and thanks for the 10,000$ a year. That's awesome."

One more quick update.... because the more I think...

One more quick update.... because the more I think about this the more I get MAD.... I think I was actually given the run around by this doctors office...Here is the situation.

A week before my appointment I called to check that the doctors office too BCBS insurance. The receptionist told me they did, and that they had a 'wonderful insurance lady'.

I went in last Wednesday. After an amazing consult, the doctor and his office manager were surprised to learn the insurance lady had left early so I couldn't talk to her. In lieu of talking to her the office manager sat me down and showed me the fabulous deal the doctor would give me if I paid myself. I said that was great, but as a student it was not an option. I was told the insurance lady would be in the next day.

last Friday I had my MD fax his recommendation to the PS. When I called to check that it was received the insurance lady was again not in.

Yesterday I called to speak to the insurance lady, and was told she would call me in 15 minutes. She didn't. When I called later she had gone home.

Today I called again and was put through to the office manager who told me that I had a 4000$ deductible, and there was no way to know if insurance would pay until after because of "standards that need to be met" (I am assuming she meant the Schuner scale)... She then offered to ding another 1000$ off the doctors price if I pay myself. I was very frustrated, because this still leaves me at 9000$... or a lot more then the 4000$ deductible.... I asked if they could please just submit it to my insurance and see what happens, and was told someone would call me back.

I'm going to make a wild assumption that no one will call me back.

Plus, don't almost all insurance companies use the schuner scale?! And, it seems I will easily meet its requirements...

So, I am thinking they don't truly accept insurance very often... They just say they do to get you in the door and hope that if you can pay once you get your heart set on the doctor you will.... if you have a situation where you can't pay (like being a student) they just never call you back...

This is infuriating, since loved the doctor so much.... I'm just going to have to sit with this a few days and decide what to do...

Any advice here ladies?

Dramatic day with a lot of up's and downs! I found...

Dramatic day with a lot of up's and downs! I found out this afternoon that there is a bit left over from my old college fund that I can use for the surgery :) So, I will be able to pick my own doctor and pay out of pocket! Whaoo!

Now I just have to decide whether to hold the run around that my favorite doctors office gave me against them.... It left a terrible taste in my mouth.... Waiting for a lot of phone calls that were never coming....
It Definately seems like they are giving you the run around. I had a hard time when I first looked into this procedure and calling surgeons finding one who takes insurance period, so I went on my insurance companies website and through my primary care dr I was referred to one who accepts insurance. A lot of drs do not take insurance because they do not get paid as much as they would cash pay, on my explanation of benefits for my surgery the dr billed $6000 but agreed to be paid only a little over $1000 through insurance. She said there are some insurances even she won't accept anymore I was just lucky she took mine and she did an awesome job I am completely happy. If I were you I would try going through the insurance company to see what they can do for you it can't hurt. I was very nervous to get approval due to being denied through my parents insurance 20 years ago but my dr told me it shouldn't be a problem and it wasn't I suppose she knew all the right things to say to get me approved. Best of luck to you, don't give up and keep us posted :)
Thanks for the encouraging words :) I am looking through my insurance companies web site right now and all I can say is.... YUCK! The doctors who do take it seem to literally disfigure their patients :(

I called the manager of my college fund today (I'm now in grad school and mostly through using it, but was very lucky to have it) and asked if I could dip into that to pay for the procedure... I expected a hard no, but instead learned his aunt had one years ago and it so radically changed her life that he is going to see if we can do it... He even told me to start picking out dates with the surgeon because he is confident he can get me the 9,000$.

So, I have a few irons in the fire right now... It's maddening, but I have a pain in my shoulder to remind me what I am fighting for every time I start to think it might be too much trouble/not meant to be :)

Well, I woke up this morning with a clear head and...

Well, I woke up this morning with a clear head and was excited to realize that I am no longer handcuffed by insurance. Even though I loved the doctor I had selected, I think I should also meet with two of my top choices who I wrote off because they didn't accept insurance.

I am going to consult with Dr. Linda Li, who a friend went to and adored, and Dr. Titelbaum. I *might* go down to SD to meet with Dr. Saltz as well, although I don't think recovering in San Diego would be the best.... Her work is amazing though, so we will see :) I'm excited! And if after these I still want to stick with my first choice despite my profound unhappyness with his office managers treatment of me then I will know for sure it is the right choice.
Sorry to hear you have been having trouble but that is exactly how I felt once I learned that my insurance company would not cover it - "no longer handcuffed."

Just for perspective - you may have gotten the run-around from your doctor's office; it's hard to know (though it sounds like it). But it IS true that insurance companies are not only denying coverage to patients more and more often, they are also paying doctors less and less. It's happening to all doctors, by all insurance companies. And it definitely becomes a problem, especially for surgeons, because they still have to pay for their own insurance coverage (malpractice, etc) - I know plenty of surgeons (including OBs, etc) who don't operate anymore because they can't make enough money to make it worth the liability.

Anyway, that is neither here nor there for you - best of luck finding the doctor that is right for you, without having to worry about if your insurance company says it's OK for you to go there! You will get there...
Yep... this makes sense...

I am sure the insurance gives doctors a terrible deal. Quite sure. I think very few people in this country would argue that insurance is great for the doctor or the patient. Plus, all the surgeries doctors are doing for 1,000$ that the insurance pays, like mentioned above, mean that when someone DOES come and pay out of pocket they make up the slack... So some people pay 1,000$ to the doctor, while others pay 10,000$.... It's ridiculous. Totally ridiculous.

At any rate, this guy is a top doc and I am not surprised he doesn't want to or have to deal with that... what I am upset about is the fact that I was lied to, then ignored. Telling me they would file paperwork then simply never calling me back is REALLY cold and disrespectful. It makes me doubt their whole ethical standard if they treat patients with that little respect once they realize they can't pay out of pocket.

Ah well. Thanks for the well wishes :D I will meet with a few more and see what I find :D The good news is that with the economy how it is I am calling people I called pre '08 and found out charges about 15g to find they are all now charing around 9! Talk about a discount :D

Hi Ladies :D Sooooo I'm getting excited to meet...

Hi Ladies :D

Sooooo I'm getting excited to meet with my first insurance free consultation this week! I got a lot of papers from his office and I have to say I LOVE how thorough this guy is so far.... His paperwork included questions like whether I have family and friends supporting my decision to undergo surgery, and whether I worry more about looking "overdone and fake" or "underdone/ not enough change" more.

We will see! I am still hoping for a mid December to early January surgery date, so I will likely only do this consult and *maybe* one more then select a surgeon and get going!

P.S.-- Any wavering motivation I may have...

P.S.-- Any wavering motivation I may have potentially felt as the time gets closer has been nullified by the fact that I have a big old rash under my boobs where my bra has been rubbing..... Urrrggggg.
Hi Lexi we're the same size and weight(127lbs and 32FF) and I also have decided to pay out of pocket. What I am finding is that most of the top surgeons are reluctant to work with the insurance companies. It took me a while to come to this decision but this is my body, not a car or a house where fixing is only about the money...think risks and pain! I am happy for the people who can get coverage and find great surgeons but it's not the case for me. Best of luck in searching for a PS. I have my consult on 28th Nov..totally excited! keep us posted looking forward to seeing your pics.

Alright guys, it's official! Barring something...

Alright guys, it's official! Barring something unforeseen like an issue with my blood work I will be having my surgery December 27th!! IBT's here I come :D :D

Not too IB though.... Still hoping to stay around a D. The doctor explained to me that I have a quite large breast base (who knew that was a thing) and as a result anything much smaller would take on a very odd and unappealing shape on me. That's fine! Hubbs will be happy the girls are staying on the largeish side, and I am sure the major difference between a 32D and a 32H will make my back quite happy!
I'm happy for you. I wonder if my base is big...never thought of that. 32D is a great size especially because we are used to having boobs. I think 32DD for me. Working out is part of my life so I do not intend to gain weight. Are you posting pics?
Yes this guy took a ton of seemingly random measurements and determined the wide base :p Right now though I guess I am wider at the bottom of the breast then where it attaches to my body, and that is very bad (or so I am told). Post procedure my wide base will be the widest part :p It DOES make a lot of sense though... I see a lot of breasts that end up a very funny square shape, and I guess that is what happens when the breast is made too small for the base....

So I decided that I needed to do everything I can...

So I decided that I needed to do everything I can to be comfy during the wait and bought two new custom bras....32I cup now 8(
32I? Wow...you are going to feel amazing after you have this done! I will be so anxious to hear how you feel physically and how you feel about yourself...
I know, I can't wait to see how I feel!! I have been living so long with the back, neck, and shoulder pain that I have gotten used to it... I can't even imagine not having all this weight on my ribs... I bet it is going to feel amazing! I am so antsy for it to happen. Never mind no having to wear bras that are so tight and uncomfortable anymore....

Just a quick update.... Doc thought he could get...

Just a quick update.... Doc thought he could get me in late December because there was someone who had selected their date but not paid the deposit yet.... Then they came though and paid :( He is out of town most of January, so that pushes me to May (my next break from school). It's a wait, but the new bras are helping, and it is 100% worth it to know for sure I am getting it done with the perfect doc for me :D
Name not provided

I feel weird posting this for some reason? Like it's a reverse HIPPA violation, lol. PM me for name if interested :)

Was this review helpful? 1 other found this helpful