Help! I've got insurance problems

joanf Member Posts: 10
edited March 2014 in Breast Cancer #1
Anyone out there had to do battle with the insurance co's whose got some advice? I have to get a mastectomy. I want to explore reconstruction and I'm getting a hassle from my HMO about going out of network for my plastic surgeon. A lot of doctors at my hospital have dropped off the plan. The only doctor they've offered me is not board certified. I'm just going into the appeal process. I know by law they have to cover this (I'm in NYS). I'm just wondering does anyone out there have any pearls of wisdom of how to handle the appeal. Oh, by the way, the insurance industry SUCKS!


  • I've never had a problem with my HMO, but it sure is the LAST thing you need right now! I'm not sure of the procedure, but there must be some kind of insurance board in your state, have you tried calling them? Also publicity may work in your favor - I've noticed quite a few people going on the radio, TV, in the papers, etc. that are having the same problem you do, maybe that would light a fire under your insurance co.
    We're all rooting for you, hang in there.
  • nganga4
    nganga4 Member Posts: 17
    There is a law that protects women who have had a mastectomy. I'm not sure whether it covers people going to surgeons who are not board certified. I am having my reconstruction done by the chief resident of the plastic surgery service at my hospital. He is not board certified but his supervising attendings are and he's doing a great job. If you have had a mastectomy, you are legally entitled to all the surgery to restore symmetry.

    Get a really good malpractice lawyer in your corner. The New York State Bar Association has a legal referral center (I'm in the Bronx) and they are very, very good at referring you to the appropriate attorney. Good luck.
  • geral
    geral Member Posts: 130
    Suggestions: 1)Contact ACS re:Women's Health & Cancer Rights Act; 2); 3)

    Good luck and take care,