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Looking for Help to Get Insurance Approval - Minneapolis, MN

I am looking for suggestions on how to get...

I am looking for suggestions on how to get approved by insurance. I saw a PS in May; who said insurance would "cover me, no problem", she then submitted my claim and I was denied. They denied me because I need more documentation and they have a minimum amount of 500cc removal per breast, the PS had put down 400cc removal. I am 5'1" and 125 lbs.; so my 36DD breasts are huge on my small frame although I don't know if the PS will be able to remove 500cc of tissue. I have a return appt. with the PS on July 31st to see if she can remove 500cc. I have also sent her a letter and records from my chiropractor that I have seen for years for neck and back pain to submit with my appeal. I would appreciate any suggestions that people have to help get the insurance approval. Thanks.

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internet, she has been rated as the best woman doctor in MN

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Comments (6)

Iowa, thanks for the letter. I did recently get a mammogram, I will have to get a copy sent to the PS. I will keep you posted.
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Sorry, Sammy, I just saw that I've already messaged you with the appeal letter. If I can be of any help, please let me know.
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I was a 34H and was approved by Blue Cross Blue Shield. I had not quite 500gm removed from each breast. I was approved right away. I am not quite 5'1" and 140-ish. I will message you with a sample of an appeal letter that I found online. I didn't need to use it, but had it ready just in case. I had documentation with me of back pain, some injections I had been given of Toradol for pain relief, mammogram reports that said my breast tissue was quite dense and not only medical records(as I didn't have a lot that said my issues were specifically from my breasts) but also a personal letter from two providers that spoke to the fact that my breasts were too large for my frame and felt that it significantly contributed and would continue to affect my mobility. Good luck with your appeal. Please let us know how it goes.
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Hi! All insurance companies have a "CC Requirement". There is an absolute minimum that must be removed otherwise you will be denied. Most insurance companies (Aetna & BCBS especailly) require a minimum of 600 cc's per breast that need to be removed. You should also start making visits to a chiropractor for back & neck pain. That physican can also write you a letter of recommendation to assist you. I went through several denials with Aetna until I finally ballooned to 160lbs with a 34HH cup. I was denied with a DDD cup, an E cup, and then an F cup. I obtained letters from my OB/GYN, chiropractor, and primary physician. I also saved receipts from Massage Company and specialty bra stores. BE PERSISTENT!!! DON'T LET YOURSELF GET ANY LARGER!!! IT'S HELL!!! Good luck girl!
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Thank Vixen for the support, I have seen a chiropractor for several years, but I have never talked to my primary doctor about back pain or getting a reduction; not sure if it would help to consult her at this point. I don't plan to gain weight, although I am definitely not trying to lose weight either; although years back when I did weigh a little less my breast size was about the same. Just wish the insurance companies would be more willing to take body type into account. Hopefully it will go better the second time around!
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I hadn't seen my current doctor much regarding my back pain either, but I just made an appointment with her, told her what I was needing. She asked me questions about the pain and then documented everything I said, including the rash she saw, the indentations in my shoulders, and the fact that in her professional opinion that my breast size significantly contributed to my inability to exercise and that a reduction would improve my quality of life. I told her about how it was hard to exercise, especially anything aerobic, and that even youg wasn't easy because my balance was affected. I don't know how much of a contributing factor that was, but she was totally on-board with it and very willing to write an influencing note.
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