17yo DD wants elective surgery!

[Calliaz]

Another data point--I had it covered when I was about 20. They did have to show I had back pain and my parents had to pay out of pocket. The insurance had an amount of breast tissue that needed to be removed to make it cosmetic. Once the surgeon certified that more than that amount was removed, my parents received a check. I think they got a short-term loan to cover the 30 days that they were without the money.

You may need to have the doctor submit for pre-approval and be denied. Then you can write an appeal using the insurance's appeals process. In many cases like this (procedures that could be cosmetic), the insurance easily approves on appeal, but drags their feet on the way there.

 

[pantherlj]

For OP and the other poster with a 16 year old that wants to do it ..... DO NOT do it until the child is DONE growing. I don't know when full developed occurs but I know it's not 16. You can PM me if you have any questions.

 

[rynosmom]

I had mine done about 12 years ago when I was about 32. I wish I had gotten it done much sooner but like others have said I was waiting until after I had my kids. It was the best thing I had ever done. I went from a DDD to a C. I had all of the issue's that everyone has described. I can tell you that you really need to ask, ask and ask again. My insurance company rejected me the 1st time and after I wrote a letter to them and they reconsidered. Good luck to your daughter.

 

[ccgirl]

My beautiful dd wants a breast reduction. There is nooooo way we can afford the $12K-$15K it will cost. She has talked about this surgery for 2 years now. We have been to the surgeon who says there are "some" instances" when insurance will cover it but he cant guarantee me it will be covered. If I had the money I would do this for her in a second!!!! My heart breaks for her every day! Shopping for clothes is a nightmare! Forget bathings suites! Bras run me around $80 each and they look like your grandmothers bra!!! White, tan, black - nothing cute, frilly or sexy for sure!!! I dread prom season in a few months!

Has anyone else gone through this procedure and had it covered? What did you do to make it happen?

I really want to do this for her......

My best friend had it covered too. At first then denied but she then had to appeal. I believe it was BCBS. And, I never thought hers were ummmm....overly large shall we say.

 

[angierae]

For OP and the other poster with a 16 year old that wants to do it ..... DO NOT do it until the child is DONE growing. I don't know when full developed occurs but I know it's not 16. You can PM me if you have any questions.

She'll be 17 in a few week, so she'd definitely be 18+ when we actually got to the point of doing it (probably the summer she's 18 and a half, right after she graduates high school) so yes, I'm aware you shouldn't do it too young. But thanks for the reminders!

My best friend had it covered too. At first then denied but she then had to appeal. I believe it was BCBS. And, I never thought hers were ummmm....overly large shall we say.

Keep in mind many of us with very large breasts are VERY good at hiding them. No one believed me when I said I was a 40I.

 

[Disney Addicted]

Yes, but hiding them and being uncomfortable because of them is NOT fun.

Honestly OP - I cannot see how this cannot be covered. Keep at the doctor and whoever else you need to get this approved!

I wish I could go back in time and have mine reduced. My mom even approached me about it back when I was 18. At that time I never even realized my breasts were big. Never even thought of it.

By my mid-20's I realized. I'm tall and always had backpain. Straps digging into my shoulders leaving red welts. Underwire leaving bruises. I had the opportunity, it would have been covered - and I chickened out.

Now I'm in my early 40's and I wish, I wish, I wish I had it done!!

 

[curlyjbs]

Thanks everyone for the kind words and encouragement! We've been to the surgeon for a consult. He took measurements, markings, photos etc. He feels it's a no-brainer but says that BC/BS is the hardest ins company to deal with for this particular surgery. He is a private Dr from a Plastic Surgery Practice not a surgical center or anything. His assistant said she will submit everything to ins co for the pre-approval but some of you are saying I should call them? Should I? or should I let them handle it? I don't know what or what not to say LOL - I don't want to jeopordize anything.

Thanks again!!!!

 

[jeepgirl30]

Just wanted to say good luck to you and your DD. Hopefully she'll get a christmas surprise out of this!

 

[dismichelle]

Thanks everyone for the kind words and encouragement! We've been to the surgeon for a consult. He took measurements, markings, photos etc. He feels it's a no-brainer but says that BC/BS is the hardest ins company to deal with for this particular surgery. He is a private Dr from a Plastic Surgery Practice not a surgical center or anything. His assistant said she will submit everything to ins co for the pre-approval but some of you are saying I should call them? Should I? or should I let them handle it? I don't know what or what not to say LOL - I don't want to jeopordize anything.

Thanks again!!!!

I wouldn't call until after a decision's made. You may just be overthinking and you could have an approval very soon.

 

[It'sWDW4me]

Thanks everyone for the kind words and encouragement! We've been to the surgeon for a consult. He took measurements, markings, photos etc. He feels it's a no-brainer but says that BC/BS is the hardest ins company to deal with for this particular surgery. He is a private Dr from a Plastic Surgery Practice not a surgical center or anything. His assistant said she will submit everything to ins co for the pre-approval but some of you are saying I should call them? Should I? or should I let them handle it? I don't know what or what not to say LOL - I don't want to jeopordize anything.

Thanks again!!!!

I wouldn't call until after a decision's made. You may just be overthinking and you could have an approval very soon.

This! It very well may be approved without issue. If you get a rejection ..... call away!

 

[DISdreamin']

Now I'm in my early 40's and I wish, I wish, I wish I had it done!!

I had just turned 40 when I had my surgery. If you feel it is still needed, go for it!!! I never felt better than once all that weight was off my chest. FWIW, I had 8 pounds removed, total. That is a LOT to be carrying around on shoulders, and my back and shoulders hurt FAR worse than I realized. It had become normal background pain to the point where you really didn't give it much thought - it was just the way life was.

I will never forget the first time I did dishes post-surgery. I turned around at the end, looked at my husband and went "my back doesn't hurt!!!" I never realized what I felt (this horrible neck and back pain from being bent over the sink) wasn't normal! That was when I knew, without a doubt, that the surgery was a good move long-term. That kind of strain simply cannot be good for your body.

Others have mentioned BFing. Neither of my kids figured out how to latch, likely because of my size. We worked with lactation consultants in the hospital and after we got home. I tried for, literally, months to get my son to latch. Pumping was simply horrible - I did it for nine months with DS (and let me tell you, those big guns came in handy for pumping - I was a veritable heifer!) and 3 months with DD. It sucked, both literally and figuratively. Maybe if I had the surgery beforehand things would have been different, who know? But not doing surgery doesn't guarantee you anything as far as successful BFing.

 

[Lisa loves Pooh]

My friend had it done when she was in college. She suffered with back pain that would not go away.

A relative of one of my in-laws had it done recently. Much older than my friend was by a good decade or so. Same issue--back pain that would not go away. I am not clear on whether or not insurance covered her issue though as I am not sure she actually had insurance when she had it done.

Typically--the way my insurance works...if there is an elective surgery--you exhaust all other avenues and if the pain remains, then they likely will cover the surgery.

So the only shot you have if it is indeed about physical health and not just disappointment in having a large cup size.

Good luck!

 

[hmacmahony]

I had a reduction 2 years ago. I also have BC/BS and live in NJ. It took almost a year to get it covered, also seeing a chiropractor weekly, and doing PT for almost a year. Worth it in the long run.
BUT....I personally am glad I waited until I was older.
Odds are she will NOT be able to nurse her babies if she has a reduction. I waited until I was done having kids so I could nurse them first.
(surprise, baby due in feb!! And I am so upset that I probably won't be able to nurse him).
I feel better, I can run, jump, and have little to no pain. BUT...for me nursing was worth the wait for me. I would not of given that up for anything.
The insurance will cover it, it just takes a long time. Expect to get denied the first time, and with the chiro, and PT I was covered within a year.

 

[RachelsMommie]

I had breast reduction when I was 18. Our insurance didn't cover it. But it was the best thing I have ever done. I'm 34 now and have FABULOUS breasts.

 

[carrie1626]

My beautiful dd wants a breast reduction. There is nooooo way we can afford the $12K-$15K it will cost. She has talked about this surgery for 2 years now. We have been to the surgeon who says there are "some" instances" when insurance will cover it but he cant guarantee me it will be covered. If I had the money I would do this for her in a second!!!! My heart breaks for her every day! Shopping for clothes is a nightmare! Forget bathings suites! Bras run me around $80 each and they look like your grandmothers bra!!! White, tan, black - nothing cute, frilly or sexy for sure!!! I dread prom season in a few months!

Has anyone else gone through this procedure and had it covered? What did you do to make it happen?

I really want to do this for her......

I can only offer support- I'm a mom of a 22yr old who has wanted nothing more than a reduction for the last 5 years. There are still tears when we shop together. It breaks my heart to see my daughter so unhappy with her body. We plan on starting the doctor visits to document the back pain and neck pain, hopefully my husband's insurance will cover it before she's not under the coverage anymore. Prayers to your daughter

 

[Pooh Girl 71]

This is the best advice on dealing with ins companies. If one person tells you no, ask for someone else, or a supervisor, or that person's supervisor. There's always someone above the person you're speaking to unless you get to the president of the company

That's not the way it works with insurance companies. The customer service rep or their manager isn't going to be able to approve something like that. The medical director does. Now if the medical director says no, then keep appealing it!! I didn't mean to single you out, worked for an insurance co. years ago and was a cust. service rep.

 

[krcit]

I had one when I was 26, about a year after having my oldest dd. Best thing I ever did. Mine was covered in full with no problems and I was a DDD. I sympathize with you and your dd. My dd is very large also and if she wanted a BR I would completely support her.

 

[Piecey]

My surgeon handled getting the insurance company to cover it. I started the process at 18 and had it done at 19, my parents insurance company covered it fully.

The first time he tried to get coverage, they denied it. Then he appealed and he said a plastic surgeon would have to review the request (whereas the first time any doctor could be the one to approve/deny it) and it was approved.

He used back pain, the grooves in my shoulders, potential arthritis, and a strong family history of breast cancer to get it approved. He also took pictures and drew his proposed surgical lines to show the plan.

HTH.

 

[AlwaysMoving]

Did anyone here need a reduction as a result of pregnancy hormones? This was my experience. I was normal size before pregnancy, added many sizes during pregnancy, and gained even more the week after birth and none of it went away. I had my reduction a year after my son was born and never chanced another pregnancy for fear it would happen again (as warned by my doc) and insurance might deny me a second surgery (as warned by the insurance co).

 

[Disney Addicted]

I had just turned 40 when I had my surgery. If you feel it is still needed, go for it!!! I never felt better than once all that weight was off my chest. FWIW, I had 8 pounds removed, total. That is a LOT to be carrying around on shoulders, and my back and shoulders hurt FAR worse than I realized. It had become normal background pain to the point where you really didn't give it much thought - it was just the way life was.

Thanks for the info! I have been thinking of it. I'm trying to lose weight and my new doctor would like to see if that will make a difference. Personally I'm not so sure that losing weight will take enough off the breasts to make a difference. But I do need to lose weight regardless.

He used back pain, the grooves in my shoulders, potential arthritis, and a strong family history of breast cancer to get it approved. He also took pictures and drew his proposed surgical lines to show the plan.

How does a family history of breast cancer come into play with getting approval for a reduction? Does a breast reduction reduce the odds of cancer? Or is it something else? My mom went through breast cancer.