| [Forum] [Shop] [Donate] [News] [Help] [Search] [Register] [Login] |
| You are not logged in |
|
| ||
|
The letter, as seen below, worked for a member in her appeal to CIGNA. =========================================== I am writing to appeal Cigna's decision to deny coverage for my bilateral reduction mammoplasty (ID number XXX; claim inventory #XXX). The reason listed for denial was that it is not medically necessary. Breast reduction is medically necessary in my case for reasons that I have outlined below. It has been also been recommended as a proper treatment for my condition by all of my regular physicians (see attached letters), and according to my Cigna policy, should be covered. My large breasts have long placed an enormous strain on my body and have negatively affected my quality of life. Their size (32DDD), position (extremely pendulous), and excessive weight on my small frame (5'3 ½ ", 105 lbs) prevent me from maintaining proper posture. My shoulders are perpetually and noticeably rounded forwards causing constant pain in my neck, shoulders, and upper back. This pain intensifies upon any sustained effort to sit or stand up correctly, with my spine straight and shoulders back, a situation that adversely affects my daily life at work and at home. This postural dysfunction is not only painful; it has created the visible beginnings of a permanent and damaging curve, or kyphosis, as my spine responds to the tremendous counterweight of my breasts. I have tried to manage the pain caused by my macromastia for at least two years by performing a regular routine of weight training and stretching exercises (at home and at a gym), many specifically targeted toward strengthening my back and chest. But the size and placement of my breasts makes it impossible to achieve full range of motion, and they interfere with any movements that require balance. Because of their disproportionate size, no bra provides adequate support and coverage. Even when wearing two sports bras at the same time--a necessity for any form of aerobic exercise--the bouncing is extremely uncomfortable and causes soreness in my breasts that lasts long after the exercise is finished. The constant chafing from the straps of these sports bras makes the skin around the strap area red and inflamed, and has caused a permanently rough and bumpy texture (see attached photos). The substantial weight of my breasts has produced a noticeable indentation in my shoulder where the bra strap digs in (see attached photos). These bras also compress and rub my areola and nipple areas together with so much friction that painful skin tags have formed that have had to be removed and biopsied (see the attached dermatopathology report). After exercise, and during the summer months especially, the undersides of my breasts and the skin beneath and between them becomes very moist and I have to constantly wipe it down and apply ointments and powders to stave off the skin rashes that otherwise appear. In addition to these problems, I also experience intermittent but acute numbness in my fingers, a condition for which no cause unrelated to my breast size has been determined. Along with exercise, I have also tried massage and physical therapy (see attached letters), as well as analgesics. These measures provide only temporary relief from the pain, which resumes as soon as the procedures are finished or the medication wears off. Every day I wear the strongest support bra available--the Champion DDD sports bra--but even these garments have to be modified for me. The plastic snaps they come with are not strong enough and pop from the weight of my breasts, so I have to have them professionally replaced with heavy metal ones (see attached photo). Still, these bras do not give me sufficient support, and thus do not aid in relieving any of the pain I experience. At night it is difficult to find a comfortable sleeping position, because when not confined in a bra, my breasts spread across my chest and fall underneath my arms. I frequently wear a sleeping bra to control this, but the discomfort this garment causes often disrupts my sleep. It is clear after many years that such measures will never improve what has increasingly become an unbearable situation. Furthermore, my postural difficulties, the attendant pain, and other problems will only become worse as I get older, requiring more complex and costly treatment, a fact with which all my physicians concur. Finally, the massive size of my breasts prevents me from taking advantage of the best new digital mammography technology currently available--my breasts are simply too large to fit into the machine. This inability to have my very large and dense breasts properly screened is of grave concern to me, as I have an immediate family history of breast cancer, and have already had one benign fibro adenoma removed. For many years, my regular physicians have strongly recommended that I have a bilateral breast reduction, as no further conventional treatment of either a manipulative or medicinal nature will permanently alleviate the pain caused by my macromastia. Please let me know if any additional information will be helpful. Thank you for your reconsideration.
-- |
| ||
|
a -- |
| ||
|
d -- |
| ||
|
q -- |
| ||
|
1 -- |
| ||
|
e -- |
| ||
|
/ -- |
| ||
|
61106 -- |
| ||
|
kar -- |
| ||
|
031907 -- |
| ||
|
051207 -- |
|
