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Thread: Breast Reduction-Help

  1. Senior Member
    HunnyBunny's Avatar
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    #1

    Breast Reduction-Help

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    I recently had twins which would make us a family of 5 now. I breastfed all my children for 6 months. I've had 2 breast tumors removed which put me through 3 biopsies and 2 surgeries. After my post-op appointment I had asked the surgeon if he could put in a referral to plastic surgery for a reduction. He said absolutely, you're a great candidate for it. I am just under 5 feet, average small body and wear a 36DD and still fall out of it. They HURT my shoulders, back and just plain hurt themselves. So I went for the consultation with the plastic surgeon. It was off post but that's where tricare sent me with their referral. I recently got a denial letter after my pictures and complaints were sent in by the surgeon. I don't understand. I do plan on calling them but I thought they covered a cosmetic surgery whether it was medically necessary or not. I don't understand what else they could possibly need from me to be able to qualify for this. My neighbor had it done because she went up a few sizes after having 1 baby and they approved it. I am crunched for time because we will ETS in a few months. The plastic surgeon said they can do it right away after approval but what is the problem with triwest?? Anyone have an experience with this?
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    #2
    i know they only do plastic surgery if needed. The surgen might have to put it in more then once
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    #3
    I agree, if that surgeon won't talk to the ins company and appeal the decision, hopefully you can get a second opinion. I would talk to a surgeon who specializes in breast reconstruction post-mastectomy because they are usually good at dealing with insurance. Many cosmetic surgeons do not want to deal with it and would rather have cash patients, kwim? Personally I got procedures covered by insurance but it took my doctor calling the ins company and appealing over the phone (in addition to an initial diagnosis, pics, etc). PM me if you are in CA and I can try to help more. Good luck and be persistent!

  4. I'm from the south and sometimes I have a big mouth
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    #4
    You may have to get them to try again. I had a reduction paid for by tricare a couple years ago.
  5. Just your everyday, laidback Aussie Girl
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    #5
    Maybe there was something on the referal that the Dr left out and that is why it was denied. I would call Tricare and find out from them why, it is probably just something small.


  6. michelle
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    #6
    i was always told you have to try VERY hard to get tricare to cover that...even if its needed you need to push the issue with them...make sure you let them know you need it
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    #7
    they are having me go through physical therapy before i can be even sent to a plastic surgeon and I am 5'3 and have 32G or H depends on the bra and I am a small build. I hope you can get it approved

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