38 Years Old, 5'6", 187.8lbs, 36J

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I have been large breasted since high school. At...

I have been large breasted since high school. At 98 lbs, I was a 34D. I am currently 195lbs and a 40DDD/G cup bra. My goal is to be approved for a breast reduction by my insurance, reduce my breast size, be able to run/swim/exercise without pain. To purchase bras without having to go to a specialty store.

Working towards my goals.

Working towards my goals.

Hello again. I took the winter and spring months to actively work on losing weight. In November of last year, I weighed in at 207lbs. I am now 187.8 when I weigh in first thing upon waking.
I have seen stories where women lost weight and avoided a breast reduction procedure. Not here. I am still a very full 38DDD cup. I guess that would be a G? Not really certain, but...this does bring me back to the desire to have a breast reduction surgery. I lost band width but not cup size.
I have spoken with my husband, insurance provider, pcp and prospective plastic surgeon. My consultation has been scheduled for early August and I am very hopeful.
My back, neck, shoulder and jaw have hurt for so long...I always just assumed it was poor posture. It is kind of shocking that it is poor posture due to having a heavy chest.
The next few weeks I will focus on improving my strength in my upper back and chest. My reading shows that this will help with recovery should I get approved and with supporting the weight should I not. After my consultation, I may begin actively dieting and exercising should the insurance say this is a no-go. I have to live in this body for life and need to find some way to come to terms with the weight of my chest if I cannot get approved for the procedure.

First Consultation

I am excited that my first consultation is quickly approaching. I am very nervous that I will get the rejection or be told to lose more weight. I am sitting at 188 currently.
I am just so tired of the neck, back and shoulder strain. That slight, constant, burn at right between the should blades from trying to always stand straighter and support this chest. I can see the kyphosis more during the summer when wearing tank tops and bathing suits. I know that will never go away, but have no wish for it to worsen with age.

Consultation Was Very Nice

I had a consultation today with a PS in my area that accepts my insurance. I never even considered how many doctors would simply say NO because of our insurance through my husbands employer.
The PS, and his staff, were very pleasant and personable. All of my questions were answered and I felt as if they actually cared.
The PS did the normal routine of pictures, a video describing breast reduction, we discussed the amount of tissue that needed removal and what recovery can be like. He even addressed the pros and cons of having surgery.
He feels pretty certain that I will end up being, should everything get approved, a large C to small D cup. I commented that the size seemed large still. He stated that the size he was aiming for was approximately half my current breast size. That just blows my mind.

A more accurate measurement?

I used this website today: http://www.brasizecalculator.tk
For so long, I have oozed~poured out of~ bubbled up from my 40DDD bras. No wonder. According to this site I am in fact a 34GG to 34HH in UK size which makes me in between a 36j-34L in the US. Where would I even find those sizes?

Denied due to plan exclusion

I contacted my insurance today to see if there was any word as of yet about my consultation and request for breast reduction surgery. They said, yes...you are denied because of a plan exclusion. I have gone round and round with them, as my insurance does have it as covered based on necessity. Now I have to do an appeal? which makes no sense if it the plan simply has an exclusion. Ugh.
The part that burns me up the most is that it was the insurance company I contacted before going to a PS. I consulted with the PS they said was covered as long as criteria was met. They sent him paperwork for what is required. He sent them documentation, this morning, and they denied it as soon as it crossed their desk because of plan exclusion. I feel as if I have been run around on a goose chase for no real apparent reason at all.

The Wheels Is Still Spinning

Still awaiting results from the "peer to peer". My insurance has gone from a chilly reception ( having questioned their decision) to me receiving daily updates to what is occurring. I know insurance is very much a business and must be handled thus, it is just hard when there seems to be little "human" applied during a request for a very personal surgery.
As of today, the peer to peer has been scheduled and I should receive word sometime this week. The coordinator at UHC says she will personally call me as soon as she knows what the decision is. She wants no more "hands in the pot" as she put it. I greatly appreciate her understanding. Not only is it hard to accept that yes, I am overweight and in need of a breast reduction but not because I am overweight....but continually explaining the desired surgery, why I need it and my anatomy really is uncomfortable. Embarrassing even. I really am thankful she has taken this case on for me and understands.

The Very Unprofessional UHC

Pissed I am. In the beginning of all of this I contacted my health insurance provider. I called to confirm what my benefits entailed: i.e. breast reduction surgery for medical necessity. Yes, I was told. I was given advice on inpatient vs outpatient. Did I have an in-care doctor selected? Yes. If not she could help me locate one. Not needed. I scheduled the consult with the suggestion of whom to see from my PCP. I went. The criteria from UHC has been faxed over to him, that morning, by my insurance company. We did the consult, I had all the criteria and he wished to remove more than the schnur scale required. GREAT!
I was denied before they ever even looked at the claim. I know this now, after days~weeks~nearly a month of daily phone calls back and forth with the insurance. I was told to appeal, then not to bother. I have been told a peer to peer had been scheduled and that an answer would be given in two days, it was never scheduled. I was told breast surgery is covered, but not under my plan. Then I was told UHC never covers them. I was sent a letter siting my EOB section 8 as reason for denial. Contacted my husbands OHR, got a copy and found this not true either. It says no cosmetic breast lifts for cosmetic appearances. However, all claims for medical will be reviewed in depth. Called UHC and explained that perhaps somebody should actually read the section they are siting, and was then told she never reviewed the claim, simply denied it. It was denied at 10:56 the day it was received, yet somebody at UHC called at 11 and requested pictures of my breast. Who? They don't know. Who received them. It does not reflect in my file. Where did these pictures get received at? No record. So somebody at UHC has pictures of my breast that never documented having requested or received them and that had noting to do with the review of my claim. A claim that was never reviewed.
I raised hell! And, yet again was told, another investigation will be completed. Please be patient.

Appeal time...for what it is worth

I have accepted that the likelihood of getting a breast reduction approved by UHC is not in my future. They have misinformed, misdirected and miscommunicated with me to the point that I am not even sure what they cover anymore. That being said, I will simply have to accept the way my body is and work on being happy with the pain, discomfort and deformity that my large breast are causing me. It is hard to say that, but it is the reality of the situation.
My PS encouraged me to file the appeal. We went ahead with that today on the off chance that somebody other than the clinical care coordinator from before will actually read the file.
They admitted to simply denying it last time without review.
If something should change, I will update.
But as for now, take care ladies and good luck to all of you are your journeys.

The clock is ticking...

On August 5th, I visited the plastic surgeon Here it is October and still no word on the appeal approval or denial. I did get a letter informing me that they are reviewing it. Never a word of apology at all on the cluster boink they have done with communicating with me. Nevertheless, January 1 we are changing to CareFirst of MD. Approval or denial, I refuse to remain a client of UHC.

Appeal Denied

UHC decided to deny my appeal. They sited that it is a policy exclusion....again. Again they give no code for the denial and no further information. I again contacted customer service and inquired about the recorded phone call being pulled from early August during which I was told breast reductions are covered. Nobody knows what I am speaking of. I have been encouraged to file another appeal, with the same company.

Beginning the whole process with a new insurance.

Hello. I am giving it a go...again. We now have BCBS Advantage (it covers chiro care!!!) and will be getting more opinions on if a breast reduction can be accomplished under coverage.

Nearing 40 Now. New Insurance

Hello again all. This is what I received from my new insurance company when I contacted them in regards to breast reduction:Benefits for reduction mammoplasty procedure are provided when all of the following criteria are met:

1. The procedure is necessary to correct documented physical symptoms and/or documented functional impairment.

2. The attending physician in the hospital record documents a detailed description of the physical symptoms and/or functional impairment expected to be relieved by surgery.

3. And the following is documented.

Patient Weighs Breast Tissue Removed
0-130 lbs. = 400 or more grams each breast
130-200 lbs. = 500 or more grams each breast
200 + lbs. = 600 or more grams each breast

Pre-determinations are no longer performed by CareFirst. This indicates current criteria used by our medical review department to determine medical necessity. This is not a prior approval of benefits and all claims are subject to medical review.
Your benefits are considered at 100% of the allowable amount for In Network providers and considered at 60% of the allowable amount for out of network as well as subject to your annual $600 deductible. Please be advised non-participating provider can balance bill for any amounts not covered by your plan.

Can anyone explain to me if this means I get it done and then they determine if it was warranted?
Dr. Wayne Ledinh, MD

I had a consultation with Dr. Ledinh. He was very courteous, straight forward and prompt. I had no issue with understanding what he feels can be accomplished with a breast reduction. My appointment went as follows: I arrived to my appointment about 10 minutes early. The office is clean and very new looking. There were three receptionist working, one addressed me as soon as I approached the counter. She was cheerful and polite. Checked me in and handed me paperwork to fill out. I sat down with the standard type of medical history and symptoms paperwork. At my exact appointment time, I was called back by a nurse. My husband was with me and we were both greeted cheerfully. I was invited in an examination room, asked a few questions about history of complaint and then had my weight taken. The nurse then placed a monitor in front of us that played a video demonstrating reasons, procedures and results of breast reduction. The examination room was very clean, up to date and well lit. Following the video, approximately 15 minutes after being assigned the room, Dr. Ledinh and his nurse returned. He introduced himself to my husband and I. We discussed my history of weight gain, discomfort, office visits and symptoms. He then asked permission to do photographs and measurements. We discussed what size I could be should he remove the amount required by my insurance and handed me a breast implant that roughly showed the amount that would be removed. He was clear to state that everyones results are different. He was very clearly spoken, polite and never once was I uncomfortable with the exam. He also spoke with my husband in regards to his feelings, post-op care and his desire to keep me overnight at the local surgery center post-op. Overall, I feel the practice is clean, well organized and very well staffed. Dr. Ledinh explained everything very clearly and detailed important things to consider. He was never hurried in his exam or discussion and asked several times if we had questions about any part he had explained. He spent approximately 30 minutes with us for the consultation. I am now awaiting approval/denial from my insurance company and will update when I hear something further.

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