Question:
I Need Help, Suggestions, Etc. Re: Getting Pre-Approved for a Breast Lift

Hi - <p>I just got off the phone with my cosmetic surgeon's office... sigh :P <p>My surgeon's opinion (which I agree with) is that I do not have enough viable breast tissue to do a breast REDUCTION; that I need a breast LIFT, and possibly implants (once the surgery gets under way, he'll try to make me a C with what I've got - if he can't, he'll insert small implants to get me there). <p>I have back, shoulder, and neck pain, as well as migraine headaches, and I have two primary care doctors, and my ob/gyn who said they'd gladly write letters stating their opinion on my need for the surgery. <p>The surgeon's office has never pre-certified anyone for a breast lift before, so before they submit the paperwork, they would like as much documentation from all of my other doctors as possible (not an issue). <p>But I'm also wondering if I should include a letter from myself, telling the insurance company that I HAD TO start wearing a bra in 3rd grade, that I have been teased and ridiculed all my life because of the size of my breasts, and that their size prevents me from enjoying my life now, because even though I've lost 130 lbs., I still cannot run, do aerobics, horseback ride, or anything "jumpy." <p>Any advice that y'all have would be greatly appreciated :) <p>Thanks! <br>Shawn Bryan    — webgrrlie (posted on June 10, 2003)

June 11, 2003
Have you researched the archives? Seems like I have written about this several times already. I had a breast lift that was paid for by insurance. The insurance company (United Health Care) had a formula for the amound of ptosis (droop) that was required for a lift. I more than qualified at Level 4 (the worst you can be of course!) I had the lift and paid for implants ($800) myself. You need to research your insurance policy's requirements regarding reconstructive surgery. AND FINALLY never never never say "cosmetic surgeon" or even "Plastic surgeon" when dealing with insurance. Say "reconstructive." That's more accurate anyway; we are being reconstructed to achieve a normal appearance following the deformities caused by the ravages of morbid obesity. And yes: you can quote me. hugs, Ann rny 9/10/99 260/124
   — [Deactivated Member]

June 11, 2003
Check with your insurance company to see what they require as far as information. I hate to say it, but if you didn't have enough tissue for a breast reduction, your insurance company may reject your request for coverage of a breast lift because it is cosmetic. Or, you may be initially denied and then need to appeal the decision. Given your physical discomforts, you might get a denial reversed on appeal. I don't think the insurance company is going to really take into account how having large breasts affected your quality of life. But, if you can justify the need based on how the discomfort affects your everyday functioning, and perhaps how it impacts on the work you do, you might be able to get their attention. I wish you the best of luck!
   — koogy

June 11, 2003
I believe most insurance company use pretty much the rule of thumb that it MUST be medically necessary. Do not mention anything about how it has effected your life mentally, just stick to the facts; example - back pain, rashes, etc. Good Luck and let me know if you do or do not get approved. Oh yeah, one more thing..... be prepared to get denied at first. Most insurance company's deny at first. Don't give up and appeal their decision.
   — Jeanette D.