Does anyone know if medi-cal covers breast reduction?

Discussion in 'Fibromyalgia Main Forum' started by lovethesun, Jan 26, 2006.

  1. lovethesun

    lovethesun New Member

    I am a dd and cannot stand fully erect because of the weight.I have a bad disc in the thoracic area.When I hold my breasts up with my arms,I don't hurt nearly as bad.Linda
  2. jaltair

    jaltair New Member

    however, if it's a medical necessity and the doctor shows that it is, it will. Talk with your doctor. It may be considered a necessity as it could affect your disc.
  3. 69mach1

    69mach1 New Member

    ask your dr...

    i know i have kaiser and medi-=cal picks ;up the co-pay...and i know my pain dr...said a couple of times i may want to get them reduced...i said i had the problem before i had the breast implants...

    i was nice 34c before and ended up 36d after the surgery...well 35lbs later i went up to like a 38-40d yuck i can not stand it...

    i need to lose weight...and i will think about gett ing those taken out maybe...i miss just finding tops that fit now... i looked good at the 36d...

    jodie
  4. cindymindy

    cindymindy New Member

    Lovethesun, I had a breast reduction in 2001 and it was the best thing I've ever done. It won't take all your pain away in the neck/shoulder area but you will feel alot better without the extra weight.
    Insurance will cover it if your doctor says its medicaly neccasary. You need to see a plastic surgeon first for a consultation. He will take your measurements and he will be able to tell you if you are over the normal size, and if you are its considered medical,they have measurements they go by. He will also take a picture of your breast without your face showing to send to your insurance to support your claim.
    My doctor told me they ususally try to get out of paying for it and that it could take up to 6 months for them to approve the surgery. They are hopeing you will change your mind.
    I knew if I had to wait 6 months I would probably chicken out. So I started calling them from the time they received the claim. I also made a couple trips to the ER room and when I called them I would mention that I had been having to go get ER treatment for the pain and that I would have to keep doing that until my surgery was approved.
    I was approved and had the surgery within 1 month of my consultation. You just have to keep bugging them and let them know you are not going to give up.
    Good luck and I know you will be very happy and you sure will feel alot better!
    cindy

  5. 69mach1

    69mach1 New Member

    did medi-cal pay for it????

    jodie
  6. 69mach1

    69mach1 New Member

    will cover the surgical procedure is what lovespun needs to know anyone???

    i just don't know for sure i have an idea that they may...

    jodie
  7. cindymindy

    cindymindy New Member

    Yes, I kept calling them and they approved (paid for)the reduction. The plastic surgeon can tell you if you meet the guidelines for medical reasons.
    OUCH - I know how your friend felt. My doctor removed 2 pounds from each breast and that still left me with a nice C cup. If I had my choice I would have had more removed. After being that big for so long I would have loved to be flat chested! I asked him for an A cup, A for all gone! He just laughed and said he would give me a nice look that matched my body size.
    Yes it was alot of weight to carry and a big relief afterwards.
    cindy
  8. 69mach1

    69mach1 New Member

    wow that is good medi-cal paid for the reduction i didn't think they would...just you know how the state works...

    good job...

    jodie
  9. cindymindy

    cindymindy New Member

    My breast were not implants so I'm not sure if they cover to have those taken out. That might be a different issue.
    cindy
  10. 69mach1

    69mach1 New Member

    i guess i will takle that one after my sleep study, my bowle problem which very well may be related to my back...i guess i may need another mri on my thoracic area...they only did my cervical and lumbar down...

    i just really do not want to be cut all up...my plasteic surgeon that did the implants back in year 2000...is the best probably in the country...harvard grad...


    anyways he only went thru the nipple into the milk duct...he did not do the one where they cut around the aroula...

    he is faboulus...great results...if no one will pay for it then i will do consider paying for it myself...

    i just can not have the implants taken out with out them doing a lift...because they were put under the pectoral muscles...can not tell the are there...jiggle and everything the real ones do...no loss of sensitivity what so ever...

    well one thing at time for me...

    i hope linda can get hers done and paid for by medi-cal...

    and a good doctor///


    my sister had hers reduced in high school then again after her first baby... her second doctor didn't do a good job...

    well thank you and wish the best for linda


    jodie
  11. lovethesun

    lovethesun New Member

    my doctor brought up breast reduction first,asked me if I thought that I needed one.I told her I needed to think about it(like I've said before,she's a great fibro doctor) I talked it over with my husband also,he said anything to reduce my pain.I weighed my brest before and they are between 5 and 7 lbs,I can't remeber the exact weight.Thanks to everybody for your input.It's a big decision.Linda