POSTED UNDER Breast Reduction REVIEWS
Won my Exclusions of Coverage Appeal! 37, 34G to 34B? - Chicago, IL
ORIGINAL POST
I've wanted a BR for years for the standard...
casper36June 22, 2016
WORTH IT
I've wanted a BR for years for the standard reasons - back pain, etc, etc. I have a couple of aunts who have had them and saw a surgeon a couple of years ago: I didn't like him so didn't pursue it further. I have particular issues with upper back/neck pain and nerve compression in my right arm. I am also hypermobile (double jointed) so my neck is especially strained because my ligaments don't hold things together the way they're supposed to
I got absolutely fed up and my sister's friend had recently had one with a surgeon she liked so I made an appointment. Then I discovered my insurance had a blanket exclusion for BR. I spent about 3 weeks being furious and started physical therapy to try to stabilize my neck.
Then I started researching. I found some court cases where judges ruled language like the one in my plan didn't excluse medically neccssary breast reductions and wrote a very lawyery letter arguing that their interpretation was wrong. I was absolutely stunned when they called me to tell me I won my appeal this week.
That almost never happens with these kind of exclusions.
When I met with the surgeon she told me she tries to get to a B. I have no idea what that looks like - any suggestions on an app or the like? I currently measure 43" around the bust and a B would be more like 36". I'm a medium framed 5'4"
I don't have my pre-op visit until 8/3 so I have way too much time to wonder what to expect.
I work at a desk in an office - nothing physcial. The surgeon said I should be able to go back to work on Monday (following a Wednesday surgery). Thoughts?
I got absolutely fed up and my sister's friend had recently had one with a surgeon she liked so I made an appointment. Then I discovered my insurance had a blanket exclusion for BR. I spent about 3 weeks being furious and started physical therapy to try to stabilize my neck.
Then I started researching. I found some court cases where judges ruled language like the one in my plan didn't excluse medically neccssary breast reductions and wrote a very lawyery letter arguing that their interpretation was wrong. I was absolutely stunned when they called me to tell me I won my appeal this week.
That almost never happens with these kind of exclusions.
When I met with the surgeon she told me she tries to get to a B. I have no idea what that looks like - any suggestions on an app or the like? I currently measure 43" around the bust and a B would be more like 36". I'm a medium framed 5'4"
I don't have my pre-op visit until 8/3 so I have way too much time to wonder what to expect.
I work at a desk in an office - nothing physcial. The surgeon said I should be able to go back to work on Monday (following a Wednesday surgery). Thoughts?
UPDATED FROM casper36
4 days pre
So ready to get this show on the road. 5 days.
casper36August 12, 2016
I am a little concerned about the anesthesia, but otherwise I am just so impatient.
Q - how long did it take for the swelling to go down enough that you really *felt* smaller?
I was getting dressed for the gym yesterday and thought "I will never have to wear this bra again."
We're going on a trip in January. I bought a regular tankini top. Two actually, and even with a pair of bottoms it cost the same as one bra sized bikini top. I will so have to fight the urge to buy a bunch of new clothes ($$$). I have a stash of stuff that barely fit when I was 25 and things I never should have bought that I am getting out of storage this weekend.
Q - how long did it take for the swelling to go down enough that you really *felt* smaller?
I was getting dressed for the gym yesterday and thought "I will never have to wear this bra again."
We're going on a trip in January. I bought a regular tankini top. Two actually, and even with a pair of bottoms it cost the same as one bra sized bikini top. I will so have to fight the urge to buy a bunch of new clothes ($$$). I have a stash of stuff that barely fit when I was 25 and things I never should have bought that I am getting out of storage this weekend.
Replies (0)
UPDATED FROM casper36
1 day pre
48 hours to go
casper36August 15, 2016
We have a boat on a local lake. When it's choppy, it bounces up and down. The running joke when there are big waves is "hold on to your boobs." It was very choppy yesterday. Ouch.
When I was taking off my bathing suit, I thought "This is the last time I'm ever going to have to wear this one." I think i will burn it.
I bought some front closure sports bras at wal-mart yesterday. I forgot how cheap bras can be. Wow.
When I was taking off my bathing suit, I thought "This is the last time I'm ever going to have to wear this one." I think i will burn it.
I bought some front closure sports bras at wal-mart yesterday. I forgot how cheap bras can be. Wow.
Replies (2)
August 16, 2016
Same here we have a boat and I hate when it gets choppy. I look around and other girls are fine me I'm holding them down in my ugly bathing suit because only certain ones fit right. My surgery I planned 8/31 so this the last summer I'll have to deal with that.
We also have a trampoline at our camp lol imagine! I can't wait to jump without 2 bras on or the joke me of me getting black eyes from jumping.
We also have a trampoline at our camp lol imagine! I can't wait to jump without 2 bras on or the joke me of me getting black eyes from jumping.
August 23, 2016
Yay for cheap bras. I'm 4 months post-surgery, and I have a drawer FULL of cheap bras, I love it! I used to hate going into the bra sections, now I stop in every time!
Replies (8)
Welcome to the community. This is one of the best things I have ever done for myself and I love the results. I had taken 2 weeks off and then had to extend it another week. After having been through this recovery I would recommend taking 2 weeks at a minimum. I was wiped out!
Conjunction with, or Treatment of breast hypertrophy or hypermastia. Therefore, all requests seeking coverage of reduction mammaplasty must include all required documentation before a medical necessity determination can be made.
Reduction mammaplasty for symptomatic breast hypertrophy or hypermastia in patients who are 18 years or older may be considered medically necessary when ALL the following criteria are met..." Do you think I can use the same blanket exclusion argument in my appeal? I don't have a lot of documentation because I haven't been to the doctor in years due to having no insurance. I've gone ahead and scheduled Chiro&OBGYN appts for next week. I'm not gonna stop fighting this. Any advice from your end? Can we private message so I can pick your brain? Thanks and I hope you're pleased with your results!