My Aetna Breast Reduction Journey 💕 — Approved in 3 Months!
I wanted to share my breast reduction journey because I know a lot of people are wondering how the Aetna process works and how long everything takes.
I started by going to my primary care doctor and telling them that I was uncomfortable and that my breasts were basically unbearable for me. My doctor gave me a referral to a plastic surgeon.
Step 1: Plastic surgeon consultation 🩺
I got in with the plastic surgeon within about a month of getting my referral.
At my consultation, I basically explained how uncomfortable and unbearable my breasts were and how much I wanted/needed a reduction.
I also told them that I had done physical therapy before. I didn’t actually have proof/documentation of the physical therapy, so I’m honestly not sure what happened with that part or whether it was even used in my authorization.
Step 2: The surgeon submitted everything to Aetna 📋
My surgeon submitted the request to Aetna for my breast reduction.
Then came the part I was NOT expecting…
Step 3: Aetna initially denied me 😩
Aetna uses the Schnur scale when determining whether a breast reduction meets their medical-necessity requirements.
The problem with my first submission was that my surgeon was a few grams short of what Aetna required based on the Schnur scale for my body measurements.
Aetna basically determined that the amount my surgeon originally planned to remove wasn’t enough to meet their requirements/wasn’t enough to be considered medically necessary to relieve my symptoms.
I was so upset because I thought that was going to be the end of it.
Step 4: My surgeon appealed 💪🏽
Instead of giving up, my surgeon appealed the denial.
He adjusted the estimated amount of tissue that would be removed to the amount that was actually needed to meet the requirements and demonstrate medical necessity.
The appeal was successful…
🎉 STEP 5: I GOT APPROVED!!!
Aetna approved my breast reduction!
And the crazy part is that this entire process — from getting my referral to getting my approval — took about 3 months total.
🥹 And now I’m at the pre-op stage!
I literally just got the call this morning telling me to go take my nicotine/cotinine test for my surgery!
So now I’m officially at the point where I’m completing my pre-op requirements and getting closer to actually having the surgery. 😭❤️
My timeline was basically:
Primary care appointment → referral → plastic surgeon consultation within a month → insurance submission → Aetna denial → surgeon appeal → amount to be removed adjusted to meet the Schnur scale → Aetna approval → nicotine test → surgery scheduling
Honestly, I wanted to post this because I know insurance approvals can be SO stressful, especially when you get that first denial.
My biggest advice is don’t automatically assume a denial means it’s over. In my case, my surgeon appealed it, corrected what needed to be corrected, and I ended up getting approved.
And now I’m just sitting here like… I’M ACTUALLY GETTING MY REDUCTION 😭😭😭🎉
Hopefully this helps somebody else who is currently fighting with Aetna! ❤️