POSTED UNDER Breast Reduction REVIEWS
41 Year Old Mother Of Three W/Hyperthrophic Breast - Riverside, CA
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Denied for breast reduction!!!! In June 2015, I...
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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!
Replies (15)
August 7, 2015
Hang in there im in the same boat as you rash and all.Appeal the decision and do not give up.
August 7, 2015
Thank you so much for your response. It really means a lot. I had a rough evening when I got the call, but now I'm ready to fight! Going to do what's necessary to get the decision overturned.
August 7, 2015
I've also been denied...twice. I'm now on the 3rd level appeal. Don't give up; I'm not! My doc said that some insurance companies will make you go through several hoops---I plan to appeal all the way to the state if necessary. I can't wait to get these massive melons off my chest!
August 7, 2015
Thank you so much for sharing! It really means a lot to me. I was so heart-broken last night, but I woke up with a renewed sense of fight in me! Going to spend my day gathering all of the documents from prior physicians and current physicians so that I can submit along with my letter of appeal.
August 10, 2015
Insurance companies thrive on people who don't have the will or strength to appeal! Go get 'em Tiger!!!!! You've got this!
August 11, 2015
Thank you so much for the encouragement! I am going to give it my best shot! I'm currently gathering supporting documents, and will have everything submitted before the end of the week. My gynecologist was equally upset with the denial, she wrote a letter of support for my appeal. And my primary care physician's nurse told me that even if they deny the appeal, we will start the process all over again, and again, and again until we get what we want! That made me feel better. It's exactly the support that I needed!
September 14, 2015
What was the reason for the denial?
September 14, 2015
I was denied because the medical group felt that there was not enough documentation regarding my symptoms and rashes. I've since won an appeal.
Dont give up, fight for yourself
Best of luck!