POSTED UNDER Breast Reduction Reviews
24, Tall and Toned. I Did Not Choose the Boob Life, the Boob Life Chose Me. - Traverse City, MI
UPDATED FROM Lynn_91
Feeling defeated :(
Lynn_91October 1, 2015
I started working on my appeal at the beginning of August but it took some time to get documentation and recommendation letters from everyone. By the time I submitted my appeal at the beginning of September it was over 40 pages. I had notes and a letter from my physical therapist, I had a letter from my chiropractor, I had notes and a letter from my regular doctor, I had notes and a letter from my surgeon, I had pictures taken at the surgeons office, I had pictures of my own that showed my ribcage literally bleeding from the weight of my chest on my bra cutting into my skin, I had a 5 page highly detailed letter of my own referencing every incident of pain that affects my well being, I had three medical journals that supported reductions of less than 500 g, I had EVERYTHING that you could possibly have in an appeal, and I still got denied.
Tomorrow I will call the number referenced on my letter to find out why specifically I was denied and to keep fighting this battle.
But as for tonight? Tonight, I will cry.
I can't keep living in this much pain. I can't do it anymore.
Tomorrow I will call the number referenced on my letter to find out why specifically I was denied and to keep fighting this battle.
But as for tonight? Tonight, I will cry.
I can't keep living in this much pain. I can't do it anymore.
UPDATED FROM Lynn_91
Extremely Frustrated!
Lynn_91July 24, 2015
I got a call from my surgeons office today and it was not good news. They contacted a rep for BCBS (the insurance that I have) who pretty much told them that he didn't think I would qualify. So what did the surgeon's office do? NOTHING. They didn't submit anything to my insurance, just wrote me up a quote for $10k. I am so frustrated that they thought that was acceptable. I asked them to send me the "checklist" that the insurance rep had sent them so that I can start making my own case for my insurance company. I know that the reason the rep said I probably won't get covered is the Schnur Scale. I just can't believe that my surgeon didn't even try to make a case for me. Anyone who has had success appealing to an insurance company, PLEASE help! Send me examples of letters, anything.
Replies (5)
July 24, 2015
Wow. How frustrating! I would maybe try going to another surgeon who is willing to jump through hoops to get you covered. It boggles my mind that some insurance companies make it so difficult. I'm hoping someone will chime in with a sample letter for you!! I have Kaiser so I didn't have to do anything, thank goodness. Best of luck. Don't give up- that's what insurance companies hope you will do so they don't have to pay. Be that squeaky wheel!
July 24, 2015
Unfortunately I live in a rural area so my choices of surgeon are limited. I really liked this surgeon when I met with him which is why it surprises me that he did that. My insurance has already had to pay $3,000 for ONE MONTH of physical therapy that I did earlier this year so you would think they would authorize the surgery to save themselves money in the long run! If this was their way of trying to dissuade me from surgery they've got another thing coming, because this fight is far from over :)
July 25, 2015
Write them a letter a very long one! There's no reason they shouldn't approve you! I have blue cross I don't know how different your ins is but mine was approved in about a week to 10 days good luck to you girl!! you deserve it
July 24, 2015
Look up MorganStaser on here and read her review. She was in a similar situation and petitioned her insurance (and won). She had offered to send her letter to someone else and may do the same for you if you ask. Also I do agree with Deborah that you may wan to consult another surgeon if your surgeon's office is not prepared/willing/motivated to help you with this. Good luck! :)
July 25, 2015
I got denied initially but they changed their tune after a letter from my chiropractor. Do you think your physical therapist would write you a letter in support? You might have to give up a lot of tissue but it would be worth it.
July 25, 2015
I might have the letter from my chiropractor if you want to see it. IM me, if so.
July 30, 2015
I would definitely try going to another surgeon or petitioning with your insurance company. My friend (who has been my advisor through this process) had a BR 2 years ago and went through a similar issue. She simply went to a couple doctors that she found here on RealSelf, acquired a few letters from them along with her primary care physician and physical therapist and re-submit her claim.
Hopefully this helps!
P.S. quite a few surgeons on here do offer free consultations, so look out for that (;
Hopefully this helps!
P.S. quite a few surgeons on here do offer free consultations, so look out for that (;
October 3, 2015
Bcbs will cover you if you get the referrals. Also you need to contact your insurance Co and get a list from them for doctors in your plan. According to the schnur scale the insurance Co said I needed to remove 650 grams for my height and weight, my doctor said all I needed was 350 grams removed. Once I sent in my letter along with my ob/gyn and GP referral, they agreed to my doctors 350 recommendation, no problem. It took less than 2 weeks. The key was getting a surgeon that was already in my plan. Good luck, I pray it works out. Keep trying.
Replies (2)
July 17, 2015
I feel for you. I had big boobs too and other girls just dont seem to understand that it is awful. I got a reduction 8 months ago. And now I feel great. Best decision ever. Good luck
August 20, 2016
Good look. Dealing with insurance isn't fun. I just got approved yesterday. Hoping for Sept 1 or 13.
Replies (5)
Kick that insurance's butt!