Disappointed with Consultation Today :-( - Philadelphia, PA

I am a 39-year-old mother of three and have had...

I am a 39-year-old mother of three and have had large breasts for as long as I can remember. I was hoping that after having children and nursing all three of them, that my breasts would shrink. Unfortunately, they did not....they only sag more than before!

I am a 38F and have been contemplating a breast reduction for a few years now. I finally had the courage to schedule a consultation with a local PS and went today to speak with him. I left feeling disappointed because he thinks I have about a 5% chance of getting insurance approval. I even had two letters of support (no pun intended!) from my physical therapist and my OB/GYN stating that a breast reduction would be extremely beneficial since PT/chiropractic/and massage therapies have not helped. Doctor said he would do the best he could, but thought he might only be able to remove 1-1.5 pounds and that might not be enough for insurance to approve the procedure. Has anyone else ever been denied by insurance and then appealed it? If you did appeal it, what information did you use? Thanks for any info you can provide!

Denied by Insurance

So I got my official letter today from my insurance company saying that they are denying the breast reduction because I am not having enough tissue removed. Doc says he could remove about 400 grams, but insurance says it should be 575 grams to qualify the surgery as being medically necessary and not just cosmetic.

I don't even know where to start now. Should I appeal? Are my breasts really an "ok" size? Starting to question my judgment at this point.

On the other hand, would insurance like to start paying for the special size bras that I would have to buy for the rest of my life? Would they also like to continue to pay for the PT, chiropractic care, and massages that are often the result of shoulder and neck pain?

I don't even know how to proceed with filing an appeal with insurance if I decide to go that route. Help! Any advice welcome.
Was this review helpful? 1 other found this helpful