I was thinking that since so many lovely ladies were brave enough to share their experience and photos of the actual surgery that it may be helpful to others to share the experience of the consultation and the approval process from the insurance company. Obviously, everyone has shared this in their story, but I want to share my experience thus far and hopefully get feedback from anyone in my place.
My story is not unlike everyone else's. I'm 25, 5'0'', 125 pounds, no past pregnancies, and wear a 32G. I've always had large breasts that have caused chronic pain in my neck & shoulders that always results in a headache. When I was a teenager my older sister had a breast reduction that our father's insurance (Blue Cross Blue Shield) covered and as soon as I turned 18 I consulted with two different plastic surgeons for the surgery. I was heart broken when both times the same insurance that approved my sister did not approve my surgery. At the time I was seeing a chiropractor for spinal pain who refused to write a letter of recommendation for surgery. I felt so discouraged and heart broken at that time that I stopped visiting that chiropractor, gave up the fight and continued on accepting to live with the discomfort and the rashes. For a few months, my parents sent me to a massage therapist to work out the tension in my shoulders and I started an alternative approach to helping my pain through yoga, which I still do today. Today, I manage my pain with advil, heat patches and yoga. I haven't bought a bra "of the shelf" in over 3 years. My bras are purchased from boutiques that specialize in bra fittings and are usually hemmed to fit my body and always cost a minimum of $100.00.
Today, I've been with a company with an insurance plan that covers breast reduction surgery. In December, I decided that I couldn't take the way I'm living any longer and that its time to try again for surgery. I found a plastic surgeon off my provider list who was board certified and had great credentials (as well as authoring a book on the subject of breast reduction surgery). I called in late December for a consultation and had it booked 2 weeks later in early January.
To anyone who is reading this and considering the surgery or consulting, I highly suggest doing research on the surgery before you consult. My first two consults when I was 18, I didn't ask any questions. I just knew that I wanted the surgery and wasn't mature enough to know what I needed to ask. This time, I researched every aspect of the surgery I could think of and this website was an amazing tool and was the first place that I could really see the real results days after the surgery. I talked with my sister at length about her surgery, her recovery, and her later pregnancies and breastfeeding. I thought of about 12 questions regarding the surgery, wrote them down in a notebook, and took the notebook with me to my consultation. My plastic surgeon let me run the appointment and he gave me honest, straight forward, and lengthy answers to all my questions. He wasn't the warmest man, but I appreciated his honesty and blunt nature more than the rosy, sunshine and smiles I got from the previous plastic surgeons that I met with who didn't do anything to help me win over the insurance company. The doctor approximated 600 grams of tissue to be removed from each breast, which I do know meets my insurance company's requirement of weight to be removed to be covered.
Here's where I feel like I've had to jump through hoops just to file with the insurance company. I feel like every other story I've read on here didn't have to go through all of this work to be approved. To file with the insurance company my doctor requires 4 documents: photos (from the consultation), a letter from my physician recommending me for the surgery, a mammogram, and a radiology report of the spine. For the record, my doctor was not 100% clear about the radiology report. Under its list of documents required for the surgery they said "any" radiology reports, which I took to mean that if you have one send it, if you don't then you don't. I can't say how lucky and grateful I am to have an amazing Internist who no questions asked wrote a letter of recommendation for me and also gave me a mammogram referral as I'm in the process of finding a new gynecologist. I did not realize scheduling a mammogram was such a challenge. At 24 years old, I obviously had no reason to ever have had a mammogram so I did not realize that you have to get a referral and then make an appointment for it. Mammograms are uncomfortable and nerve racking and I really was not okay with being exposed to radiation (and pain!) for no reason at all. I had all of this information faxed to my surgeon's office who I phoned to be clear that they all the documents they needed from me for the insurance company and I was told that I did. Two weeks go by and I call my insurance company to check the status of my claim only to find that they had absolutely nothing on file for me. I called my surgeon's office to find out why they hadn't filed my claim yet only to find out low and behold I still needed an x-ray of my spine, even though they told me 2 weeks prior that they had everything they needed.
I'm trying to be patient and understanding because I keep getting on the phone with a new office employee at the surgeon's office and she just didn't know what information she needed from me. As frustrating as this was, she's new and is making mistakes and I understand she's just learning the ropes. Needless to say, my doctor got me a referral for an x-ray for the next day and the results were faxed to the plastic surgeon the day after I had the x-ray. My results came back abnormal with my cervical spine showing Lordosis. My Internist called me about the results of the x-ray to explain that the results are nothing to be worried about are often a result of poor posture. Is that enough for the Insurance Company?
It's now February 21, a month and half after my consultation and my paperwork was filed today with the insurance company. I'm feeling so nervous about the outcome of all this. I'm afraid of being denied a third time and the helpless feeling that comes after a denial. I'm afraid that after unnecessarily exposing myself to radiation twice was all for nothing and that all my supporting documents won't be enough. I'm hopeful that third times a charm considering I have all these documents and the support of a physician that I didn't have the first time around, but there's still a huge fear of rejection.
When my sister had the surgery almost 10 years ago, all she had to do was have a consultation and the insurance company approved her in a week. Just like that. Now the insurance companies are stricter with their approvals and I'm scared that I don't make the cut. I would love to hear back from anyone what their experience was to get approved and the emotions they felt. Anyone have experience getting approved by United Healthcare? Even if I don't get approved, the lesson here for anyone considering this surgery is to be prepared with lots of questions and any documents that will support your case.