Wednesday, November 05, 2008

Ta Ta Appointment...

On Halloween, I did have my appointment with the plastic surgeon. He completely agreed with me, and even pointed out a few problems that I didn't even realize were due to breast size. Rashes under the ta tas caused by either heat or friction or both, hurting and itching either way. Excessive dryness in the winter, resulting in a papery feeling of the skin. It's also causing what looks like a "hump" of sorts at the base of my neck where my neck and shoulders meet.

He could even see the pain I was in just sitting there during the appointment. I could be sitting or standing ANYWHERE, and consciously making sure my posture is with my back straight, and the pain gets to be so much sometimes that I still end up hunching.

He did say that with the insurance we have right now, we'll be more likely to get the claim approved, but the insurance company we're moving to (Cigna) is notoriously more difficult to get ANY procedures done. They make you jump through hoops, and don't consider past therapies or weight loss. It won't matter to Cigna that I've already lost 30 lbs without results in chest size, nor will it matter that I've already completed 3 months of physical therapy, 2X per week, without results in my shoulder injury. The doctor told me that by having the weight loss, and continuing with it, as well as already having had physical therapy, I've cut about 6 months off of my wait time. Even with the steroid shot I had for my rotator cuff, I still feel pain and soreness in that shoulder, and I just know that it would be alleviated with a smaller breast size. I know it won't be a cure-all, but it'll be better than the literal agony I'm in now. I can't even exercise properly. I can't fit through tight spaces. Sports bras are a joke.

But no, Cigna wants you to do additional/new therapies and weight loss before they'll even consider covering a breast reduction. So keeping fingers crossed that Anthem approves the case when it's submitted this month. We're hoping for an approval by December 1st. I do have to get my first mammogram before the surgery, which just reminded me that I have to call to make that appointment and just get it over with.

The hardest part? Not the lump check. Not the initial once-over by the doctor. The hardest part was the photos he had to take to submit to the insurance company. They actually want photographic proof that someone is the size they say they are. I'd have gladly sent them a stretched out 42-DD bra that I can't use any more. No, they want photos. Blech.

Anyway, we're hoping for a December surgery. Likely just before Christmas. If Anthem denies the claim, then we just have to resubmit with stronger documentation, and really pressure them, because if this drags out to January and we have to submit to Cigna, it'll be a whole new claim with a whole new insurance company, and as I already stated, it will be much more difficult to get them to approve the claim. And the 6 months of time served will mean nothing, and I'll have to start over. Suckage.

So if you follow my blog, or you just stumbled upon it, please keep me in your prayers if you're the praying type, that this all works out in my favor.

3 comments:

Midwayedancer said...

I really hope everything works out. My girlfriend had the surgery and it changed her life!

♥J€§§¡¢a♫W€§§¡¢a♥™ said...

I really do hope there's some significant change. I can't imagine going through this pain, and yes humiliation, for the rest of my life. Right now, I'm in near-agony. Thanks so much, Lisa.

Jennifer said...

Good Luck!!

Changing insurance sucks. We are changing from Cigna to BCBS. I haven't had anything major going on with them but the kids so I can't tell you how they will act about what you are going through.