Question
I received my letter yesterday from good old Blue Cross Blue Shield of Texas stating that the proposed procedure is excluded under my coverage agreement. So I guess no br for me. I have no clue how much the sugery costs without it but I'm pretty sure that I can't afford it. I'm going to go cry now. Thanks ladies for everything.. I'll be back later.
Brandi
Answer
It is always an exclusion. I am on Blue Cross Blue Shield as well and they covered mine. When I first called them over a year ago they told me it was excluded on my policy and other than breast reconstruction from something like cancer, I would not get it. So I waited until my policy was up for renewel and called them to find out what policy does cover BR. The passed me around to about four people and finally the supervisor told me that all the group policies are the same and all of them exclude it. Not to switch polices and just have my /directory/index.php" target=_blank>doctor send in preauthorization stating my physical problems. My shoulder problems were well documented over the previous 6 years. They approves mine in two weeks. And I had waited six months because of what I was told. So you need to appeal this and make your case for health reasons.
Jeanenne
Answer
Thanks for replying. The coverage is through my husbands job and I am a stay at home mom of 2 so I don't have my own insurance to fall back on either. Would I need documents from my GP and my chiropractor? Why do they fight it so hard? I suppose I am just feeling sorry for myself right now. I know things could be much worse. Thanks again,
Brandi
Answer
Your PS's office should be able to handle the appeal for you. You need to call their insurance person tomorrow and ask them what the next step is. I'm sure they've done this a million times. You probably got the standard rejection letter and now just need to proceed to the appeals process. The more treatment you have had for neck and shoulder problems the better. Some insurance carriers require a minimim amount removed. Mine approved mine with 350 per side and my doctor was pretty surprised they covered it. But I had so much massage treatment over the prior 6 years that it helped make my case. They paid for my massage as well with my copay. I also had grooves in my shoulders which were /pictures/index.php" target=_blank>photographed and sent in. Basically you have to prove that this is medically necessary and not cosmetic.
Our policy is a group policy as my husband owns a business and we provide it for his employees. Since we are the owners, we pick the policy we want for ourselves and could easily have picked up a different policy at renewal time. It was when we went to renew that they told me to proceed with the pre-auth. I was so mad because I had delayed seeing a PS because of the exclusion in my policy.
Don't get discouraged. Get your ducks in order and be patient. It might take a couple of months, but there are ways around this.
There are some very informed women on this forum who have been down this road and will give you good advice.
Jeanenne
Answer
That is the biggest BS ever, and most of us get the same. Don't give up on your dream, find out why.
Get this, I qualified, or would have, for gastric, if I gained 70 lb.s I lost it alone, told them to blow it outta their butts, and got my MD to refer me to a Surgeron, ok, did not use him, did it a different way. But it is insurance. They are told to say NO whether it is life or death.
Beat this dog. Make it your cruscade and if I can help in anyway, let me at them.
BTW: I did not have the gastric, duh, but did have the BR..cost me about 4 grand in Michigan, with a discount, cuz I don't pay full price to NO one.
Sorry, better get off my soapbox.
Good luck
Gretta
Man that just cheeses my crackers, can you give us the run down on what happened? Did they measure? Take a statement? From your MD?
Pixs?
Answer
The PS I went to took measurements and pictures. I'm 5'2" and 117 pounds, (most of it boob). I wear a 34DD/E. I have had 2 babies and breastfed them both, at my largest I was a 36G. There is a lot of sag now and I think that the measurement he took from my collarbone to my nipples was around 26 or 27cm. I have been fighting migraines and shoulder and back pain since I was 13. I have tried pain meds and chiropractic care. All of this is documented. I am so frustrated because I have been told by my obgyn and my GP that I should have no problem being approved due to my history. Anyway, thank you ladies for the support and advice, and for listening to my rant. God bless you.
Brandi
Answer
hiya sweetie i am also a stay at home mom with 2 babies and on my hubby's insurance he has AETNA but as of june 1st his compnay is switching to BC/BS which i am not happy about because i hear all these horror stories but AETNA denied me 2x's for my BR and my PS appealed it and my GP wrote letters also, and finally they approved me but now my PS says i need a tummy tuck because of having my kids i have sooo much excess /mmh/product/beauty/index.vm?procid=13" target=_blank>skin i get rashes and all from it but now i am /mmh/product/scar_reduction/index.vm?procid=42" target=_blank>scared cause i have a horrible feeling that BC/BS will not cover this and i will be stuck with this hanging skin forever, go figure huh i have pretty bobies now and this ugly flabby belly.. maybe i could become a belly dancer..LMAO. keep your head up sweetie and keep fighting, don't give up yet get all your doc's to write letters on your behalf..
Answer
The coverage from BCBS is pretty good except for something like this. Tummy tucks are never covered because they are considered strictly cosmetic. Oh how I wish they were covered though. I had 2 C-sections and I have lost the weight from both pregnancies but it seems that my /mmh/product/beauty/index.vm?procid=13" target=_blank>skin did not get the memo to shrink I plan on appealing the denial but they didn't even state why I was denied except that it is excluded under our plan. anyway I plan to call and find something out. Thanks
Brandi
Answer
I agree, there is NO insurance company that is going to pay for a TT. Just ain't gonna happen.
I have to say how surprised I am that my BC/BS approved me within 5 minutes. My PS office did it all online. No exaggeration - 5 minutes and I was approved. Verbal from the PS office, although they had something printed out. 4 days later, I had a PREAPPROVED in my mailbox from BC/BS.
On a funny note. The approval said:
Approved: REDUCE LARGE BREAST
Not breasts. I said to my DH, "What about the other one?" lmao.Lost 5 lbs. on 6/19/06. Went from a 34DDDD to a C I am guessing. Still swollen.
Would I do it again? IN A SECOND!
Answer
Hi Brandi,
I have BCBS of South Carolina and I was approved in 48 hours. Just like the ladies said don't give up on your dream. Do what you have to do, meaning if you have to fight then fight til the end. I'm a 36ii cup and my surgery is scheduled for June 6th. So do a Mike Tyson on BCBS and win the fight for your BR.
Raynique
Answer
Hi Emerson! I just wanted to tell you not to give up. I have blue cross blue shield of Georgia and was approved the first time my /directory/index.php" target=_blank>/directory/index.php" target=_blank>/directory/index.php" target=_blank>/directory/index.php" target=_blank>doctor submitted my information. I am also 5' 2" and wear 34DD/E but I weigh about 145. I also breastfed 2 kids and have a bunch of sag. I have neck and shoulder problems and headaches. It seems like if they'd approve me, they'd approve you too! Just stay after them. Good luck!
Answer
tummy tucks are covered by insurance if within the folds of the /mmh/product/beauty/index.vm?procid=13" target=_blank>skin rashes and irritation are caused and you have documentation of this from your GP with treatments and other therapies tried.. my PS told me about it when i went to have my drains removed which excited me and confused me cause i was wondering why he would tell me this 36 hrs after he just cut into my breasts.. i have bad irritation and get rashes where the skin folds over so there may bve hope yet...
Answer
Thank you all so much. I call my PS's office and the insurance coordinator told me that if it is excluded under the plan then they most likely won't change their minds. I asked her about doing an appeal and she did not sound too optimistic. I told her that I have the medical problems documented(chiropractor, obgyn and GP), she said that it might help to have one of them send a letter reccomending the reduction. She also meantioned that one of the problems may be that our coverage is out of Texas and we live in /directory/search.php" target=_blank>/directory/search.php" target=_blank>/directory/search.php" target=_blank>/directory/search.php" target=_blank>/directory/search.php" target=_blank>Kansas. I'm not sure what to do now. The surgery without insurance is $5800.
Brandi
Answer
Brandi,
DON"T GIVE UP!! and certainly not because of the "insurance co-ordinator's"
reaction, she's not invested...except maybe to keep costs down.
You do have a right to appeal. I had my primary physician, my chiropractor,and my /directory/index.php" target=_blank>/directory/index.php" target=_blank>/directory/index.php" target=_blank>/directory/index.php" target=_blank>/directory/index.php" target=_blank>plastic surgeon to all mail in letters. If you physically have it done in /directory/search.php" target=_blank>/directory/search.php" target=_blank>/directory/search.php" target=_blank>/directory/search.php" target=_blank>/directory/search.php" target=_blank>Texas does that make a difference? Investigate further...
Don't Give up!
Peace,
SSD
Answer
Brandi I live in texas and dropped BCBS of Texas because they suck I could never get them to cover anything without a fight so continue to fight them and they will eventually give in however it is a timeconsuming job
Tina[url=http://www.TickerFactory.com/]
[/url]
