POSTED UNDER Breast Reduction Reviews
10 Years of Chronic Back/neckpain. Hoping Breast Reduction Will Help - Austin, TX
ORIGINAL POST
Like so many others I am completely fixated with...
WORTH IT
Like so many others I am completely fixated with this site! I am 44 years old, 5'4 barely, 145lbs give or take. I have been on medication for disc herniation and bone spurs in my upper neck and lower back since around 2006. I'm currently at a 36DD although I've never been truly measured. I have a short torso and frame so my breasts really look odd. I didn't realize how large I was until I was talking with the Dr. and saw my shoulder dents. I'll post a pic at some point, if I can get the nerve. In the past, doctors have mentioned that I might want to look into reduction. The one day that I decided to ask my OBGYN about it she turned out ill and her stand in said "Why would you do that for the sake of a few pounds of flesh?" Nice... A few years later now I am finally ready to try this. I've had many injections and RFA's, even started prolotherapy. I'm hoping this will assist in the road to recovery. Plus, although I consider this medically necessary, it would really be nice to be able to wear normal clothes. I was an early bloomer, wore a c/din school, and then went to a DD after my son was born. My doctor mentioned that I am 'heavy' in my breasts, tissue more than fat. I could have sworn doc said something about 600mg but that seems a lot from what I've read from other's reviews.
So where I am now is gathering my medical records for approval. The initial request from the doc came back with insurance asking for more information. I had only given the most recent MRI as well as recent office visit. Now I'm going back a few years. Hopefully that will do it.
I also had a second opinion today. This doctor was very nice as well. I think I will still go with Dr. Mcgee (a few reviews on this site had nice things to say). Here's hoping that insurance will be quick with their decision and I'll be updating this soon! Cheers!
katnavera's provider
UPDATED FROM katnavera
4 months pre
a very depressing daytoday
doc office called Friday to let me know she (asst who is turning in paperwork) is out next week, which I though was very nice. They faxed 38 additional pages to Cigna. She said they did not fax pictures so those are going in regular mail. Today I received a letter from Cigna that my documents (probably not the added 38 pages from my last two years of shots and RFA's) were rejected for various reasons including no pictures. I called Cigna Friday evening and was told that all information should be sent as one package. I explained the pictures could not be faxed and that the office added a note saying pictures were coming in mail. Cigna said she didn't have access to see any of that information. Great. Cigna says now I have to go through the appeals process which is longer. I would love any information that those of you who have had insurance handle your procedure have gone through. I chose this office because it really seemed like they had gone through this often and they that would really fight for me. So why didn't they know that everything had to be sent as one package? I was hoping to get this procedure done this summer. Now I think it's going to be months before we can even start again and I already have a negative against me. Anyhow... very depressed...I posted a pic finally. I know I'm not as big as many of you. I feel like I'm weirdly wide.. and I posted a couple more that hopefully show the grooves in my shoulder. I've broken many a strap pulling on them :)
Replies (5)
March 28, 2015
Is there a local branch of Cigna where you can personally deliver the pics and documentation? I know bcbs has local offices, not sure about Cigna. How frustrating.
March 29, 2015
geez you know I hadn't thought of that...good idea. I don't know how far it is, I'm sure plenty of gals including me would drive. Now that it has to be appealed who knows, but thanks for the advice!
March 29, 2015
Just fyi- originally the office sent everything to TN because that was on the back of my card, however these were supposed to go to Plano, TX..I just need to find out how far away that is from me.. also another reason why I'm upset...shouldn't the office have known that...or shouldn't the insurance put the correct address on back (TN was for claims..there wasn't anything listed for approval requests... ugh!
March 29, 2015
I had a similar issue. There were some administrative hassles in the beginning. I guess my original package did not include my chiro records or x-rays of my back showing bone spurs and arthritis (I'm only 28!) and did not include my pictures. I received a letter from my insurance company saying I had been denied because basically they did not have any information on my case. I got on the doctor's office and they got everything resubmitted as an addition, I did not have to go through the appeal process. The decision to be approved came very quickly after that. Good luck!
March 29, 2015
I'm hoping that the doc office can talk with cigna and straighten out the pic deal so that I don't have to appeal. Unfortunately it seems like you just have to have the right person on the line at the right time. Sometimes I'm allowed to speak to the approval dept...and sometimes claims tells me the aren't allowed to. sigh. Now I have to wait for a week for the person handling everything at the doc's office to get back from vacation. I hope my situation turns out like yours... I have the early arthritis myself, it's no fun!!
March 29, 2015
The insurance companies will try to make it difficult for you, but submit your photos and a letter detailing everything you have done and all your symptoms. Mine was two pages, and I included pictures as well as the bras I've used. I also had my physical therapist write a letter, and in it, he said that without this surgery, the insurance company will eventually end up paying more, as I'll need back and disc surgery. We submitted 33 pages (including all my chiropractic and acupuncture records) as well as a study I found showing that women with smaller frames (I'm 5'3" and am a 30F) benefit just as much from the surgery even if they don't have the full 500 from each breast (as my insurance was requiring, and to do so for me would have been a mastectomy). I think they just looked at my information and went, Ok, fine--we don't want to fight with you, LOL.
You can google how to do an appeal. Lots of good advice. Best of luck!
March 29, 2015
I think I'll have a talk with the assistant and ask her what she included besides just the doctors notes. Do you think the insurance bothers to read personal letters, say, from me stating everything I've been through? I would think if I totaled all my doctors visits since 2006 they would want to pay for my surgery with even the chance that it might help alleviate my doctors visits and medication costs. We'll see...thanks for your thoughts!
March 31, 2015
I think they *do* take it into consideration. From what I've heard, your initial claim goes to someone who has no specialty in services provided. They just check a list. If you appeal, then your appeal goes to a specialist, and they will take a lot more into consideration. Detail *everything.* Also total all those doctors' visits. Also, ask the doctors who have treated you to give you copies of your charts to send along and a letter from them too. I think one reason mine got approved was that my physical therapist made it clear that if they didn't grant me the surgery, then they'd end up paying for back and neck surgery down the line.
March 31, 2015
I also took pictures of my bra-strap grooving and rashes and chafe marks. I used the guidelines from here: http://www.plasticsurgery.org/reconstructive-procedures/breast-reduction.html?sub=Breast+reduction+surgery:+health+and+beauty+for+life#content
I addressed every bullet point they showed. That helped with creating an outline for my letter.
April 1, 2015
Thx for the info...its so funny...I slooked at a Kaiser checklist for br. It listed what has to be there to qualify. I have had evrrything done minus skin ulcers. Im starting to feel a bit better. If I tally up alll of this myself in a cover letter that may help. Thx so much!!
April 3, 2015
Great! I'm so glad I could help. Crossing my fingers it goes through, but if it doesn't, keep fighting.
April 3, 2015
If Cigna doesn't let it go though, appeal it. If the appeal doesn't go through, then you should appeal to your state's insurance board.
April 18, 2015
Any my pics maybe a side profile or leaning slightly forward would prove your case...where there's a will there's a way
May 14, 2015
I'm in Austin TX and I will be using Dr. Lauren Crawford for surgery in 2 weeks. She sent my insurance everything at once by mail I think. Insurance wanted more photos, she emailed them, bam! Approved instantly. Whole process was about 2 weeks. I'm stoked!
May 14, 2015
Great for you! Yes, my second doc's office seemed to be much more professional with handling the paperwork. That really puts me at ease. Good luck!
Replies (5)
I'm very happy as I do have less neck & shoulder pain. I move better , breathe deeper, more energised.
I wish I had my reduction in my 30's, as I'm now 54 , tho I do have a new lease on life.
I call healing (not pain), takes a very long time but well worth the op.
All the best to all of us ladies that take the courage to move forward.