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Denied for breast reduction!!!! In June 2015, I...
Denied for breast reduction!!!!
In June 2015, I began my journey and effort to seek approval for a breast reduction. The final straw was my getting a fungal (ring worm) infection which started under my breast. I've had it for over three months. I have always had upper neck pain, shoulder pain, indentation from bra straps, headaches, breast pain on the side (without bra). I've dealt with these issues for over 10 years. Just learned to deal with them. I guys my primary reasoning for that was the fact that I've been flat out afraid to have the procedure. I've definitely avoided the thought of considering BR during my child-bearing years because I was so afraid of losing the ability to breast feed. Also, there was the fear of losing my nipple sensation. I'm now at the point where, I'm willing to put all of my concerns aside all in the effort of seeking relief of this pain and discomfort.
My gynecologist referred me to a wonderful PS who I was very happy with. The PS was stated that he has no doubt that I would fit all of the criteria for reduction and agreed that I was a perfect candidate. He discribed my breast as being overly Hyperthrophic, and even went as far as saying that the distance of my nipple from the collar bone was one of the greatest that he has seen, which poses a greater challenge of reduction without the lost of the nipple or nipple sensation.
I am so disappointed in the denial from my insurance company, especially since I have still yet to get rid of this rash, which is the worst that I've ever had, and has now spread all over my body! It's out of control, and I feel like I'm now losing control of my hope, joy, and emotions.
I have every intention on appealing the decision, but would love some insight about how I can "properly" submit an appeal.
My insurance is through Anthem BC - California-HMO
All support is welcome!
In June 2015, I began my journey and effort to seek approval for a breast reduction. The final straw was my getting a fungal (ring worm) infection which started under my breast. I've had it for over three months. I have always had upper neck pain, shoulder pain, indentation from bra straps, headaches, breast pain on the side (without bra). I've dealt with these issues for over 10 years. Just learned to deal with them. I guys my primary reasoning for that was the fact that I've been flat out afraid to have the procedure. I've definitely avoided the thought of considering BR during my child-bearing years because I was so afraid of losing the ability to breast feed. Also, there was the fear of losing my nipple sensation. I'm now at the point where, I'm willing to put all of my concerns aside all in the effort of seeking relief of this pain and discomfort.
My gynecologist referred me to a wonderful PS who I was very happy with. The PS was stated that he has no doubt that I would fit all of the criteria for reduction and agreed that I was a perfect candidate. He discribed my breast as being overly Hyperthrophic, and even went as far as saying that the distance of my nipple from the collar bone was one of the greatest that he has seen, which poses a greater challenge of reduction without the lost of the nipple or nipple sensation.
I am so disappointed in the denial from my insurance company, especially since I have still yet to get rid of this rash, which is the worst that I've ever had, and has now spread all over my body! It's out of control, and I feel like I'm now losing control of my hope, joy, and emotions.
I have every intention on appealing the decision, but would love some insight about how I can "properly" submit an appeal.
My insurance is through Anthem BC - California-HMO
All support is welcome!
Before
Front Profile of Boobs
Before - 2010 - 20 lbs lighter
This photo is from 2010. Even at 20 lbs. lighter, these girls will not go away.
Provider Review
Dr. Joseph Ku