Waiting on an Appeal for a Reduction - Medina, OH

I am a 43 year old stay at home Mom of 4. I have...

I am a 43 year old stay at home Mom of 4. I have always felt I needed a reduction since I went from an A Cup to a D Cup in one summer of high school - I eventually ended up as an F Cup. My back and neck have ALWAYS been hurting with headaches too.

I don't know if the insurance is penalizing me because I don't have indents and constant rashes under my breast. I have always been careful to wear large padded straps and minimizers to keep me from sagging, now I wish I hadn't;( I have appealed the ruling and am waiting on their "Almighty" decision (arghh). If they don't approve it, I am considering getting the surgery done in Columbus through Ohio State's Resident Surgery program. They will do it "out the door" for about $4600 - paid ahead.

The ONLY way I can do that is to borrow the $ from my Mom who desperately wants me to have it... anyone ever go this route? I'm concerned about the 2 hour drive home after the surgery and the pain/nausea level. I may consider asking a nurse friend to spend the night with me down their in a hotel near the hospital until the drainage tubes come out. Is that one or two days after surgery? THANK YOU for hearing my story and I would appreciate any input you have.


Thanks Ladies... appreciate your excitement for me! I wish I could have done it sooner as well, but I had four kids who had a hard time letting go of their "nursies". My youngest son who is 5 STILL asks me;) after almost 2 years. Between him and my husband, I'm going to have some very sad puppies over here;)
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Good luck on your appeal. Some insurance companies go out of there way to not pay. I didn't have grooves on my shoulder or constant rashes (I had a few)...but I wore a 40J bra. My HMO wouldn't even refer me to a PS...they referred my to a physical therapist and nutritionist. I switched to Blue Cross and was able to go directly to a PS. The main criteria should be the amount of breast tissue removed. If you feel comfortable with this resident program and can afford it....it sounds like a good deal. I was looking at the billed charges for my surgery that the insurance paid and my surgery cost about 3 times that.

Taking the two hour drive the day of the surgery will not be comfortable. I would say the first day was the most painful day for me. If possible, I would stay for one night. Talk to you doctor, I visited my doctor the day after surgury...but he kept the drains in over the weekend (I had them for six days due to the holiday weekend).
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Hi severn -

The appeal was denied, but not based on medical necessity. They actually agreed with me needing a bilateral reduction, but my husbands insurance plan does not cover that type of procedure for any reason except cancer. I found a surgeon at the Cleveland Clinic who I LOVE, who is doing the surgery for only $200 more than the resident clinic and it's only 30 minutes away instead of 2 hours. I'm thrilled. My surgery is scheduled for October 5th.....counting down the days:) Thanks for you advice.
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Here's my update. No insurance coverage even...

Here's my update. No insurance coverage even though they say it's medically necessary. Only covered if cancer. I will be going in at the Clinic on Oct.5th with self pay. Got a great quote from a veteran surgeon. I'm thrilled. Will keep you posted.
Thanks Iowa - I'll keep you posted. Looks like two other ladies are scheduled the same week as me. It will be nice to compare notes:)
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Best of luck to you Micki! Hope you get everything worked out:-)
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I am happy you are able to still do this:)

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Yeah! Going in on the 5th of October at the...

Yeah! Going in on the 5th of October at the Cleveland Clinic. Have to self-pay due to NEW and (UNimproved) insurance plans that aren't covering reductions at all unless you have cancer. They better not decide to take THAT away too - that would be a horrible outrage...

I am so glad I found this...because I have been dealing with this problem for years and now im fed up im going to have my breast reduction as soon as I get the money do anybody know any doctors in north carolina...
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Here is a link to our North Carolina RealSelf Doctors.  

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singingmicki,

Congratulations!!!!! I'm scared but I can't wait to be on the other side
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Cleveland Plastic Surgeon

Fabulous guy!

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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