Went to Consult...- Salinas, CA

After speaking with my PS office we have a plan! I'm going to complete PT, like the insurance requires, and I'm also going to pay out of pocket to see my old Chiropractor from when I was 16. He is the originally health care professional who recommended I get a reduction. He will assess me and then write a letter to my insurance company. I also need to write a letter stating why I'm in need of this surgery. I will also get a letter from my PT at my re-assessment on November 25th to give to my insurance company. Man, so many hoops to jump through just to prove my need for this surgery! Once I have all the letters, my PS office will re-submit. They said my insurance CANNOT deny then because I will have complete the requirements they stated in writing. I'm hoping it will get re-submitted by the end of November! I'm feeling hopeful again.

I just received the denial letter. It states "Approval criteria for reduction mammoplasty include the requirement for 'four to eight visits of physical therapy or chiropractic care, 2 to 4 months of home exercise for cervical, shoulder, or upper or lower back pain". Has anyone gotten one similar to this? It's passed 5 o'clock therefore I can't call my PS or insurance for further explanation. I'm certain it means they want me to participate in PT before they'll consider covering the cost of the surgery. It's a let down but I know everything happens for a reason. I start PT tomorrow and will be going twice a week until the beginning of December. Bottom line is I'm roughly a size G on a thick 5'3 frame. I have permanent shoulder indents, rashes under my breasts, lower back pain and neck pain. My guess is that the person who denied my request is either a man or a woman who has never been in our shoes... Or size bra!