reconstruction deformity

catsie

I had implants placed during double mastectomy reconstruction surgery through kaiser. I also had radiation after the surgery. I now have a deformity including a dent still from the radiation and I am not symetrical. Kaiser will not correct the deformity stating that I am too fat for sugery and it would be elective if I choose to move ahead with any corrections. I have consultations from other plastic surgeons outside of Kaiser that they would correct what Kaiser has done, but would need the reccomend from Kaiser. Kaiser is refusing to do anything. Where can I turn?

It is my understanding that the Womens health care and breast cancer act required that they make me symetrical.

Has anyone had issues with Kaiser? Does anyone know what my rights are with the insurance industry? Kaiser is running me in circles?

Any help is appreciated, I am depressed and devastated from the morbid deformity.

Thanks

Renee

Teach76

Insurance help?

Hi, Renee

    I have not had an experience such as yours, but may I suggest that you contact your insurance provider for advice?  I do not know what Kaiser is( facility?). I hope that you find some satisfaction soon.

 

jessiesmom1

After my mastectomy and reconstruction I could have been a candidate for the TV show "Botched." Thank goodness my problem was fixable and my insurance paid for revision reconstruction without question.  Maybe this information will be of some help to you.

The Women's Health and Cancer Rights Act (WHCRA) helps protect women with breast cancer who choose reconstruction after a mastectomy. It says that insurance must cover: 1. Reconstruction of the breast that was removed

           2. Surgery and reconstruction of the other breast to make them symmetrical

           3. Prostheses needed before or during reconstruction

           4. Any physical complications at all stages of mastectomy including lymphedema

If you feel your rights have been violated then I would suggest you start the complaint process.

             1.Begin with the State Department of Insurance. They regulate companies that     provide health insurance. If you are in California then Kaiser is within the Department of Managed Care. I've worked for a major insurance company and those letters from the DOI were treated very seriously. They were a priority. 

            2. Contact the Cancer Legal Resource Center 1-866-843-2572

            3. Contact the Disability Rights Legal Center at www.disabilityrightslegalcenter.org

Please let us know if Kaiser becomes more cooperative with you.

IRENE

disneyfan2008

sorry to hear. Have you check

sorry to hear. Have you check with any legal advisor-what they have to do and not do?

catsie

jessiesmom1 said:

After my mastectomy and reconstruction I could have been a candidate for the TV show "Botched." Thank goodness my problem was fixable and my insurance paid for revision reconstruction without question.  Maybe this information will be of some help to you.

The Women's Health and Cancer Rights Act (WHCRA) helps protect women with breast cancer who choose reconstruction after a mastectomy. It says that insurance must cover: 1. Reconstruction of the breast that was removed

           2. Surgery and reconstruction of the other breast to make them symmetrical

           3. Prostheses needed before or during reconstruction

           4. Any physical complications at all stages of mastectomy including lymphedema

If you feel your rights have been violated then I would suggest you start the complaint process.

             1.Begin with the State Department of Insurance. They regulate companies that     provide health insurance. If you are in California then Kaiser is within the Department of Managed Care. I've worked for a major insurance company and those letters from the DOI were treated very seriously. They were a priority. 

            2. Contact the Cancer Legal Resource Center 1-866-843-2572

            3. Contact the Disability Rights Legal Center at www.disabilityrightslegalcenter.org

Please let us know if Kaiser becomes more cooperative with you.

IRENE

Kaiser refuses to fix deformity

I greatly apprecaite your list of resources. I'll start down the list. I really should not have to do this.

As of today Kaiser refuses to correct the dent in my breast stating that my life is not in danger. It is cosmetic. And that any surgery is now considered elective. What the Hell....My depression is beyond anything that can be imagined. How can Doctors allow or even want half assed attempts?

I am physically deformed. I should be able to have Kaiser at minimum fix what was damaged.

There has to be others with this situation??? Anyone?

I appreciate any help anyone can give.

Depressed and feeling helpless

catsie

disneyfan2008 said:

sorry to hear. Have you check

sorry to hear. Have you check with any legal advisor-what they have to do and not do?

Why should I have to get legal counsel when I have insurance?

It looks like I am going to have to get outside legal help, at my expense not only with time off, but with monitarily as well. A double burden.

If anyone else can provide resources, or help I would greatly appreciate it.

Feeling Depressed and helpless

catsie

Teach76 said:

Insurance help?

Hi, Renee

    I have not had an experience such as yours, but may I suggest that you contact your insurance provider for advice?  I do not know what Kaiser is( facility?). I hope that you find some satisfaction soon.

 

No KAISER Insurance help for deformity

Well to anyone considering reconstruction, implants and radiation RETHINK IT!! ask me for photos or what has transpired. I am defromed from the reconstruciton process and Insurance will not cover it.

As of today my insurance has decided that the deformity is cosmetic, is not life threataning and they will not cover any other procedure under insurance. Anything I do from this point forward to fix it through Kaiser is considered ELECTIVE!!! All out of my pocket. I can get a fix through another cosmetic surgeon and have the estimates, but why the hell do I have insurance then?

I have consulted with legal counsel and they stated they will need a substantial cash retainer and that Kaiser runs people bancrupt so they are not able to continue to fight. They stated it could take as many as 5 years to get any kind of resolution if ever. Kaiser knows this and they also demand that you go to mandatory arbitration so they keep this information out of the public arena.

I am beyond angry and depressed. Kaiser deformed me and refuses to fix it because my life is not in danger.

I am trying to work through my HR at a Government Job and am also getting no where.

I guess I will need to become a loud and strong public advocate, because this is ALL SICK AND WRONG! I can not be the only one that this is happening to. Class action lawsuit, plant myself with a poster on the public sidwalk of the hospital warning everyone of this deformity, file in district court??? Anyone??

I have been damaged through the process from Kaiser, I deserve to get put back without a dent in my breast at minimum. NO DENT - DO YOU HEAR ME KAISER!!!! NO GOD DAMN DENT!!!

Can Anyone help me? Please, the depression is overwhelming.

 

RozHopkins

If I remember correctly I had

If I remember correctly I had a second surgery under my insurane as my plastic surgeon was weigh out making mine symmetrical, he put the papers in to the insurance company explaining and  I had no problems.  I have one side with a line overstretched and spare skin on the sides but with clothes on I look fine.

bonbondidit

Catsie

Revisions for symmetry are covered by the The Women's Health and Cancer Rights Act. If you are denied this, then you file a grievence with your hospital. DID THEY ACTUALLY TELL YOU YOU WERE TOO OVERWEIGHT FOR A REVISION?? I would ask for your records and see if your body weight is the same as the day of check in for surgery as you are now. How can you be ok in weight on day of surgery but not now in time of a revision?? Lame excuses they are giving you!

Here are a few steps I would do if it were me:

Call insurance and speak to an advocate or ask to speak to a supervisor. Explain that the hospital is calling this revision"cosmetic" vs. what the law says is necessary for optimum recovery of cancer. This is a right being denied.

Next I would call PRMA - They are HUGE in San Antonio as a leader in breast cancer reconstruction and revision. There procedure comes in three stages - reconstruction, revisions and then tatooing or nipple reconstruction.  I would pick there brain with a consult. Insurance will usually cover them as well. Personally I wouldn't use Kaiser anymore and take  your business elsewhere. After all if they denied you , you certainly can't get locked into a dead end. NO WAY! ALso, GET IT IN WRITING that they denied you. Ask for an explanation letter.

http://prma-enhance.com/