I’m hoping a doc or someone will be able to answer my question. I’m a DD cup. And not a good DD. A bad one. As in, my boobs are not pretty or perky AT ALL. Lot’s o’ stretch marks and sagging. The thing is, I’m only 29. And another thing is I developed early, and my boobs never had time to be perky or pretty. I’m so young, and I’ve never known what it’s like to have nice pretty breasts like most women.
I know lots of women are not satisfied with their breasts. But mine are truly ugly.
I think what would help is a breast reduction or lift. But I can’t afford something like that. I know health insurance companies and HMO’s will pay if it’s medically necessary, like if it was causing me to have back pain, shoulder pain, etc. I mean, I do have aches and pains, but they aren’t debilitating. I don’t have weird rashes under my breasts. I do, however, find it hard to exercise the way I want to. I truly want to be more physically active than I am, but having big saggy bosoms floppin’ around is painful, and I have a good pricey aerobic bra.
Would this be enough to convince my PCP to refer me to a cosmetic surgeon and/or make a case for my HMO?
I’m almost desperate enough to fake lots of back pain and headaches, but I would feel really guilty about it, so I probably don’t have the balls to go through with it.
Any thoughts, suggestions?
Thanks guys,
Lorie
A woman I work with had a reduction done recently. Her family Dr. recommended it, and the only catch was the procedure had to remove at least 50 grams from each breast to qualify as a “medical necessity” and receive the health insurance coverage.
It’s been about three months now, and she’s very happy with the results.
Beyond that little tidbit, I’m entirely ignorant on the subject.
Good Luck.
How would anyone here know how your primary care physician will react if you ask for this?
You MUST ask, or you will get nothing. Your HMO will have it’s own strange little rules about referrals, and what is debilitating enough to have them pay for surgery.
My mom did all the talking almost four years ago when I had mine, but it sounds like I had a little more in the way of actual medical reason for the surgery, though not nearly as much as some people. I wouldn’t advise you to flat-out lie but a little exaggeration, when dealing with the insurance company, may be the only way to go. I know it worked for ME. (And I have noticed I really do have less pain in my upper back and shoulders, though I hadn’t noticed how much I was having, having been huge since about eighth grade.)
The most annoying part of that whole process was knowing that some moron sitting at a desk was looking at PICTURES of my breasts trying to decide whether the surgery was justifiable on medical grounds, after THREE different plastic surgeons had all agreed it’d be a good idea.
And don’t worry about your age. I know they used to make you wait until you’d had kids if you were going to, but that’s bull – if you’re THAT unhappy, why wait another 20 years? I was two weeks shy of my 22nd birthday when I had mine, and it was the best thing I’ve ever done for myself.
Pain from heavy breasts doesn’t necessarily have to be debilitating to qualify. The fact that it exists at all may be sufficient to get the HMO to pay for the surgery. You do need a referral to a plastic surgeon from your PCP, and in any case, a plastic surgeon should be the one to make the recommendation for surgery; after all, it’s his specialty and his expertise. You may need at least a second opinion if the first surgeon decides to recommend surgery.
However, as someone mentioned, there has to be photo documentation pre- and post-operatively. Depending on how you feel about such things, this alone may be a dealbreaker.
The best thing I can suggest is to talk to your PCP about a referral to a plastic surgeon, and also to talk to your HMO about the process required to get the surgery paid for. Don’t make assumptions about anything, and get as much as possible in writing BEFORE having the surgery. That’ll help keep you from being responsible for the entire bill.
Robin
I don’t remember any post-op photo opportunities. I was willing to deal with the pre-op ones if it would get the surgery paid for, because I’d been wanting it done since I was 14. (Then there was a mix-up with the billing and you can imagine my shock when I got a hospital bill for upwards of $7,000…but it got straightened out, thank God.) It really bothers me that people with little or no medical expertise say yes or no to procedures. As I said, three surgeons had agreed that reduction was a good idea.
My first impulse was to say lie, cheat, steal, do whatever it takes. So much of this depends on your insurance company. Breast lifts are NOT covered, as far as I know.
They took two pounds off my front. It was a drastic way to lose weight…
I couldn’t be happier with the results, though.
Thanks for the replies, folks!