So you’d think that having J cup breasts would make it easy for insurance to approve a reduction, right? Well, apparently not.
We had our consult in the beginning of August. It took until November 13th to get the official pre-authorization. In my consult, the surgeon mentioned that most insurance companies only require that a specific number of grams be removed. Because of my size, we had nothing to worry about. I was going to be losing 7 sizes in what the surgeon called fibrous breasts. Piece of cake, right?!
Um, no. So, right before I had my consult I had sent a message to BCBS to find out what their requirements were for being approved for a breast reduction. A few weeks after the consult, I got my reply and sent the information over to the surgeons office along with a letter from my Chiropractor. The requirements asked for a whole lot of other things, including a 6 week history of “conservative treatment”. This meant that I had to show that I’d done other things like take advil, use heat/cold, therapy, etc.
I remember thinking, how the heck are you supposed to prove that? I asked the surgeon if they thought I needed to submit anything else, and they didn’t think so. So we moved forward. Everything was submitted in September. In October, we got the first denial. It said we didn’t show the use of conservative treatment, and that the surgeon wasn’t planning on taking enough off. NOT TAKING ENOUGH OFF?!?!?!
When we first met, the surgeon mentioned that most insurance requires 575 grams to be removed from each side. My insurance requires 600 grams. The forms were submitted with 575 grams. On October 8th, we appealed the decision and sent over everything we had, including a letter from Dr. Witzke covering all our bases. Then we waited. Again.
Two weeks later I got a letter in the mail saying that my appeal was received and that it could take up to 30 days to review. I was devastated. The idea of getting this scheduled in that sweet spot after the show and before Thanksgiving was dwindling. I really didn’t want to have surgery close to Christmas.
Two weeks later (it’s like clockwork with these guys), we received another denial. However, the denial had the EXACT same reasons as the last one. I was so confused. Did the surgeons office not submit the right information? What was going on? It was the last performance day of the musical I was in when I read this letter. I cried the whole way there and then tried not to cry the whole show. Everyone probably thought it was last show blues. As much as I’ll miss everyone, I don’t usually get emotional over shows ending. Either way, it worked to my advantage because no one asked me what was wrong.
Monday I left an emotional message for the surgeons office and also put in a message with my customer liaison that was assigned to the case. I asked the surgeons office to send me a copy of what was sent over. At this point I kept thinking that they didn’t know what they were doing, and that maybe I should find someone else.
When they sent it over, I couldn’t believe it. It was all there. It was as if BCBS completely ignored all of the new information sent over. My contact at the surgeon’s office was livid. She took care of contacting the insurance company and trying to figure out what was going on. She called me back to say we should hear by Friday.
Friday came and went. Nothing. I thought, maybe they’re sending a letter again, instead of calling. The next Friday, the I called BCBS to find out what was going on. I had been approved. I should have gotten the letter. My husband checked the mail that day and sure enough, there was the pre-authorization letter.
Finally. I called the surgeons office and we started talking scheduling. December 1st was thrown around as the first possible date. The insurance battle was over and I could start planning to be out of work and the recovery after.