ThinnerTerri

Hi I have an appointment for a breast reduction, but my Dr says the insurance companies arent covering tummy tucks. Any advise??

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Terri
lap 12/20/04
down 106 lbs

I can do ALL things through Christ who
strengthens me!

VanessaSFL

Hi Terri,I have tossed the breast reduction/lift thing around.Have you had the consult yet?If so ,may I ask the cost?If not ,let us know.I think next year will be my PS year.

Thanks for any in put.

Van

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Van


Lap RNY March,21 2005
280/130

VPA BEAR

bridgetgirl

Blue Cross covered my tummy tuck and thighlift a little over a year ago..... my surgeon took pics, and wrote a letter... the rest is happy history!

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J.Bridget Fisher
2/9/04 lap 5'11"
298/155

www.myspace.com/caliclovercutie
We must have a theme, a goal, a purpose in our lives. If you don't know where you're aiming, you don't have a goal. My goal is to live my life in such a way that when I die, someone can say, she cared." - MaryKay Ash

ThinnerTerri

why did they cover it?...here in ny they say that is cosmetic even if some people get severe infections under the hanging skin unless they were hospitalized and put on IV they won't cover it. I have bc/bs also

__________________

Terri
lap 12/20/04
down 106 lbs

I can do ALL things through Christ who
strengthens me!

ThinnerTerri

van,
i am getting the reduction june 23rd. the insurance covers it if they can remove at least 500 cc total from each breast. i came down to a 38ddd so its covered. but i want my tummy done at the same time and i dont know why the same bc/bs wont cover my TT. i cant imagine why they would remove breast because of back issues but not the strain from the tummy?? frustrating!! i have a drs appointment tuesday and am bringing my xrays showing that when i was heavy i shifted my weight so my lower spine is too curved im praying this will get me the tt.

__________________

Terri
lap 12/20/04
down 106 lbs

I can do ALL things through Christ who
strengthens me!

bridgetgirl

Its not cosmetic, its reconstructive, You have the burden of proof showing how detrimental the hanging skin is too your health. Like at it this way,if a women needs a masectomy, if she wants it they will give her a breast prosthesis. This is elective, and cosmetic. But how detrimental is it to her psyche to llok at her chest post masectomy? Devistating. the same can be sad for us, and if anyone disagrees that you can prove without reasonable doubt how terrible ythe skin is, then its sheer descrimination. Rashes, poor hygeine, sores, back pain, shoulder pain, a pannus that hangs to your private areas... etc, this on top of the look og horrid hanging skin can be mentally devistating as well. Thinking, I lost 150 pounds, I have this pain, I look awful, still look fat (skin) become depressed and eat their way out of the surgery.
If you document your health detrements, they have no other choice but to approve. And if your carrier doesnt, you appeal, and appeal agin. If you have ot takeit all the way to the Supreme Court of Appeals, you do it. Otherwise its just descrimination. It has been my experience that most people either dont try, and if they do and they get denied they dont appeal. They find it easier to get a loan or take a 2nd mortgage on their home. If thats an option for you , cool. But for some it not.

Insurance carriers will pay for breast lifts, but NOT implants.

Good luck n stuff.

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J.Bridget Fisher
2/9/04 lap 5'11"
298/155

www.myspace.com/caliclovercutie
We must have a theme, a goal, a purpose in our lives. If you don't know where you're aiming, you don't have a goal. My goal is to live my life in such a way that when I die, someone can say, she cared." - MaryKay Ash

always

it is all in how your dr persents it to the insurance, if he/she deems it medically necessary they have to cover it...back pain, not resolved, shoulder pain...they can make it happen...i have pacific care...and they do pay for it...also many of the hospitals that have burn centers will do the surgery if you donate the skin...i do not no about breast, but it is worth checking into if your dr is not willing to submit it as medically necessary..good luck....sharon

bridgetgirl

You CANNOT donate skin, this is a myth. Your skin is broken done and scarred.The cost to take skin from a live person than from a cadever is 3 times as expensive as well.

Please understand, you cannot donate skin- it has never happened, its only a myth.

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J.Bridget Fisher
2/9/04 lap 5'11"
298/155

www.myspace.com/caliclovercutie
We must have a theme, a goal, a purpose in our lives. If you don't know where you're aiming, you don't have a goal. My goal is to live my life in such a way that when I die, someone can say, she cared." - MaryKay Ash

LizardQueen

My ins covered the tt and I think it is because my PCP documented a rash &/or a boil type sore every time I saw him from my first appt after wls. I had him refer me for a consult with a detailed letter of necessity. My PCP is great! He knew that I would need/want the tt and really helped out on this!

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Amber
Open RNY 2/22/05
278/103.5 way below goal

niki1411

Did You Go Through Your Pcp To Get The Approval. Or Do You Just Go To The Surgeon And Have Them Get Your Approval?????? Im A Long Way Away From This But I Still Would Love The Info, Thanks

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Niki
pre-op/now/goal Surgery date 2/10/06
265 / 175/ 155



http://www.myspace.com/bubbett