Help! I am in desperate need of a breast reduction and I have the Empire plan (Uniter Healthcare). I have seen a dermatogist, an internist, gotten back xrays, and the obgyn. I have complained and tried to get chart notes and asked for letters of medical necessity faxed to the plastic surgeon. All these doctors do is write on persciption pads and fax them. These are not enough. Or are they? Will i need physical therapy too for proof? Has anyone had the procedure without all this red tape? Any advice????
2007-10-09 10:47:58 · 4 answers · asked by noitall 4 in Health ➔ Women's Health
noitall,
My wife had binary breast reduction on 10-03-2007, after years of excruciating back pain. She tried our regular family doctor and all he wanted to do was push drugs; we went to a chiropractor and that didn't help, after about 12 months. She finally went to all the doctors she had seen, to include the chiropractor, and they wrote letters of recomendation to her plastic surgeon. It had to go to our insurance carrier (Anthem Blue Cross/ Blue Shield) for consideration. After about two weeks they approved the procedure. Her plastic surgeon said that he was required by the insurance company to take off so many grams per breast...according to her height, weight, and size of her breasts. The surgery took about 2 1/2 hours, and she had some trouble waking up from the anestesia, but her total time in the hospital, from pre-op registration to walking out the door was 8 hours. She said her back has never felt better (no more pain!! yeah!)...there was some pain around her breasts a couple of days after, but nothing major; her doctor gave her some pain killers. The thing is she had to wear a bra-like thing for a week, and had to put 4x4 gauze on her breasts without taking off the old ones, and she couldn't get it wet. I took her back today for her follow up and all is well; they removed the stitches and there was some swelling around one of her nipples, but nothing major. I hope this helped and if you need any more information, just let me know and I'll let my wife tell you about it. Good luck! Chris
PS I am sorry if some words are not spelled correctly, my spell check is taking forever!
2007-10-09 11:02:27 · answer #1 · answered by Brother Chris 3 · 2⤊ 0⤋
I think it's kind of strange that you would ask this being that you recently answered my BR question pretty rudely and without any experience on the matter.
If your regular doctors believe you may be a candidate for BR, then you need to get a referral from them to the plastic surgeon. Once you make the appointment with the plastic surgeon, they can help you determine whether or not a BR is necessary and if so, they should have insurance people in the office who can help explain your coverage to you.
2007-10-09 10:52:28 · answer #2 · answered by sourocean17 2 · 1⤊ 0⤋
I know your post was 3 years ago, but I am in same boat. I have UHC Choice Plus, and my company did not include the breast reduction option either. I have been researching and am trying to figure out if I would be covered under the Women's Health and Cancer Rights Act of 1998. My shoulders are deformed, not just indentations, but the bones are now curved as well, I have ridiculous amounts of pain, limited mobility of my shoulders, especially on left, curvature of spine from over-compensation, unable to exercise, and have been in a car wreck because i was unable to reach across my breasts to fully turn the steering wheel! So, to me, the reduction would be to restore physiological function to my shoulders, arms, back , and neck. So...I was hoping to find out if they covered it for your wife...and if so, did they make you pay the deductible first? (mine is $3500, then I would have to pay 70%--which if the entire thing cost 10K, I would end up paying almost 6k) If they did cover, how much was your out of pocket expense? Any information that you could share would be greatly appreciated! I know I can not accept the doctors and insurance only asking me to take tons of muscle relaxers and narcotic pain relievers for the rest of my life! ( i am too afraid to take them during the day when I work as it is!) Thank you in advance!
2016-04-07 23:53:51 · answer #3 · answered by Anonymous · 0⤊ 0⤋
That should be enough, has the information been sent in yet?
I would just use all of that information and see what happens. If its denied APPEAL like crazy.
I have United Healthcare and they covered my reduction 100%. All healthcare plans are different so it may not be the case with you (especially if your pre op size is different than mine).
Good luck in your journey. Here is a very good site for you to check out as it helped me a LOT:
http://www.breasthealthonline.com
38J to 38C Feb 2006
2007-10-10 01:17:27 · answer #4 · answered by Terri 7 · 0⤊ 0⤋