Hi Everyone,

My new plastic surgeon sent in a letter of medical necessity to my insurance company yesterday.. He is asking for a TT (which was already previously approved) a medial thighplasty

and breast augmentation. (The boobs are a long shot but he was humoring me)

Well, other than having saggy boobies, I really dont have a case for medical necessity regarding my breasts. And unless there is a really compelling reason to approve it, we are really spinning our wheels.

Heres what my PS wrote in the letter about the boobs:

In addition, she has a moderate ptosis in the breasts bilaterally.

(This basically means my breasts sag!!!)

THe procedures of choice are:

CPT codes: 15831 Panniculectomy/Abdominoplasty

15832 Medial thighplasty

19316 Mastopexy ( translated for those who dont know BREAST LIFT)

19325 Immediate insertion of mammary prosthesis

(THIS ONE HAD ME CRACKING UP! We are referring to implants here)

I wont bore you with the rest of the letter, but PLEEASE, MAMMARY PROSTHESIS?

THe rest of the letter was very compelling regarding the excess skin for the stomach and thighs, but I dont think we have a chance in hell in getting an approval for a boob job. Anyway, I thought it was funny. If they approve the thighs, I will be happy and the stomach is approved already. I will pay for the boobs cause I really dont think the mammary prosthesis is going to be approved!!

babs in TX

ah ha ha ha ha, mammary prosthesis! Of course, for women who've had a mastectomy this could be quite important.

Now, if they could only figure out a way to transfuse boobs!

So what ended up happening ? did you get the boob job approved?

If he believes that the excess skin overlap (the sag) puts you at significant health risk related to potential for/or history of infection related to yeast growth etc, you could possibly get some coverage for the lift part. I can't imagine the "prosthesis" getting paid for, but stranger things have happened! I used to work for a major national health insurance company as a claims examiner. I used to be so dumbfounded by the much needed things we didn't pay, yet the odd ball things we did cover... it's all in the wording that's for sure!