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.

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.

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...

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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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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Congratulations!!!!! I'm scared but I can't wait to be on the other side
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That's exactly how I felt too BigBoobie... but you will be surprised at how easy it is.. NOW it's going to take some time to see how they morph over the next few months. They are as hard as rocks right now;)
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Congrats!!! Hope to see photos soon!!!
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Thanks "Big Boobie" soon to be "Smaller Boobies" - I did fine.. Pain was a little more than I thought, but it's bearable. They gave me Ultram for pain... I think it's little more than Tylenol though:) Appreciated the prayers though.. My husband wasn't allowed back at all, so I sat for 2 hours by myself working myself into a frenzy... But then I felt the prayers of many and felt much better...
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I will be praying for you tomorrow. I am scheduled for October 13th
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lol:) - it's the heavy breasts that have affected our brain power all these years. Give it some time to regenerate:)
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Oh--you're right, it was Lehman! I don't know why I said Andrews!!! Sorry.
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I'm not sure that was me.....I had my first appt. with Dr. Christina Rotemberg - but it was too long a wait, so I found Dr. Lehman in Akron, but couldn't do it there because of the cost.
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My surgery was just over 6 months ago, and I am thrilled I did it, should have done it sooner! I feel great without those extra weights on my chest, have been able to wear things I could never wear before. I just wondered about the surgeon because you commented on my review a while ago that you had a consult with Dr. Andrews originally. Good luck to you!
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I know - it was so frustrating; but I had to find a way somehow..I usually don't respond overly nauseous to the anesthia, so hopefully that won't be an issue. My surgeon is Dr. Armand Lucas. I really like him. How are you feeling? How long ago was your surgery? Happy? Done anything differently? YOU can message me if you don't want to answer here;)
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That's unfortunate about the insurance stipulation of not covering it unless it's cancer. Glad you were able to set up something closer, because I don't think a 2-hour drive back from Columbus would be very pleasant after an outpatient surgery--I had mine 10 minutes away, and got a little nauseous on the drive home! Just wondering which surgeon at Cleveland Clinic is doing it? You can message me if you don't want to mention it here.
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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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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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Yay Micki! Sounds like things are moving in the right direction now!
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Thats fantastic....and it is worth every penny! We are the same age and my only regret is that I didn't do it sooner. I look forward to hearing about your progress.
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My PS thought the mammo reports were helpful as mine stated that 10% of breast cancers are undetected in women with very dense tissue. I can't believe with all of the documentation that you had that you were denied. Did they give you a reason?
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Thanks Kimmers! I'll keep you updated. I would pay a million dollars to get this done - if I had it - as it is, I don't have a pot to P in:) My mother offered to pay - but I couldn't take it without it being a loan. We'll see..
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Thank you for posting your story.  

I do remember my ride home and it was a bit bumpy and hurt a bit.  I think you would be ok on the ride home.  Just make sure your driver doesn't hit every pot hole in the road...LOL   I swear my hubby found all of them.  

You will feel like a new woman after this surgery.  It gives you a boost in confidence and takes a big load off the back, neck and shoulders.  

I had told myself that if my insurance did not cover it I was going to pay out of pocket.  I had to get this done.

Keep us up to date on what's going on with your process.

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Have you spoken with your primary care provider about your back and neck pain? I didn't have a lot of documentation about my pain since I work in the doctor's office where I am seen, but the first provider I asked was more than willing to write a letter on my behalf and I think that helped a lot. Have you had a mammogram? Does the report mention the consistency of your breast tissue? Those were two of the things that I submitted that the plastic surgeon thought was very helpful. My insurance is Blue Cross.
As far as the drive home...I live an hour and a half away from where I will be having the surgery. I had no other options as I live in rural Iowa and the drive would be that far no matter where I would go.
My insurance does allow me to stay overnight in the hospital. If I lived in Des Moines, where the surgery will be, I may opt to go home and save the money, but my doctor will place drains and I need to go to his office the following day to have them removed and be re-evaluated and I don't want to have to make that drive again.
I have my surgery next Wednesday, so I will be able to give you more of an opinion afterward, but my opinion now would be to stay in a hotel nearby that first night if you are going to have to go back the following day. If you don't have to go back to the surgeon's office right away I would go home for a day or two and then make the drive back if that is an option.
Good luck! I hope your appeal is successful
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