beyond pissed.......nipple tattooing

jendrey said:

...
What type of insurance do you have? Perhaps you can appeal the descision? I'm a little confused, was it your PS that told you your insurance didn't cover it?

There was something that the PS nurse told me wasn't covered but when I called my insurance myself I found out it was. The way it works is that the nurse had to make a prior request first before it could be covered and for whatever reason it became commonplace not to bother making a prior request.. Therefore they simply told me it wasn't covered when in fact it actually was but only if it was preapproved.

Does that make any sense?!!

As an aside, I wonder what those tattoo artists that are re-imbursed, I wonder how they go about it? Maybe some research by asking one of them is in order...

Also, what state do you live in? Some states have laws pertaining to breast reconstruction where it spells out what's what.

jendrey said:

...
What type of insurance do you have? Perhaps you can appeal the descision? I'm a little confused, was it your PS that told you your insurance didn't cover it?

There was something that the PS nurse told me wasn't covered but when I called my insurance myself I found out it was. The way it works is that the nurse had to make a prior request first before it could be covered and for whatever reason it became commonplace not to bother making a prior request.. Therefore they simply told me it wasn't covered when in fact it actually was but only if it was preapproved.

Does that make any sense?!!

As an aside, I wonder what those tattoo artists that are re-imbursed, I wonder how they go about it? Maybe some research by asking one of them is in order...

Also, what state do you live in? Some states have laws pertaining to breast reconstruction where it spells out what's what.

pinkkari09 said:

Jill, Federal law mandates
Jill, Federal law mandates that all insurance companies pay for "Complete" reconstruction for woman with BC. Please look into this, you should be able to get it covered. I have BCBS and they sent me a copy of the federal law and assured me I would be covered through the whole process.
~Kari

jikaras said:

some basic updates and info
I'm in Wisconsin - insurance is United Healthcare.

I did call them and got the general run-around........

I was first told by the male call center person that I spoke to, that I would need to find a plastic surgeon in my area that does the tattooing in their office. He was more than happy to supply me with a list of doctors in my area (63 of them), that I could call to inquire. I told him I was NOT going to call them, as I've already been told that there are no plastic surgeons in SE Wisconsin that do this. (this was all based on the phone conversation that I had with my PS. They have had other patients who want the same thing done as me, but found that insurance wouldn't pay. They already did the legwork).

So, male operator then send me to another branch of their call center, and I got male operator #2.....I explained my situation, and he said I needed to talk to someone in "appeals"....

Onto operator #3, who was female. I explained what was going on, and she said that there was nothing that she could do. She said that there were a number of things:
#1-my insurance won't cover it - it's 'cosmetic'
#2-I couldn't even appeal it, because a claim has never been submitted.
#3-because my PS isn't doing it, there's nothing to file....
#4-the cosmetic specialist who does this is licensed, but doesn't work through insurances.

I also thought that there was some federal mandate that said everything needs to be covered, but can't find anything on the web on it. If someone could e-mail it to me, that'd be fantastic (jillkaras@yahoo.com).....

What angered me was operator #3 telling me what I should do to get it covered (reconstruction with the nipple surgery)..... Don't tell me what I should do with my body! Needless to say, I ended the conversation with alot of swear words, yelling and crying and finally hanging up....

jendrey said:

...
From the Wisconsin Legislature: Statures

"609.77 Coverage of breast reconstruction. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.895 (13). History: 1997 a. 27, 237; 2001 a. 16."
(http://legis.wisconsin.gov/statutes/Stat0609.pdf)

632.895 (13)
"Breast reconstruction.
632.895(13)(a)(a) Every disability insurance policy, and every self-insured health plan that provides coverage of the surgical procedure known as a mastectomy shall provide coverage of breast reconstruction of the affected tissue incident to a mastectomy.
(http://docs.legis.wisconsin.gov/statutes/statutes/632/VI/895/8/f/2#/statutes/statutes/632/VI/895/8/f/2)

Also found this:
609.01(3)
"(3) "Limited service health organization" means a health care plan offered by an organization established under ch. 185, 611, 613 or 614 or issued a certificate of authority under ch. 618 that makes available to its enrollees, in consideration for predetermined periodic fixed payments, a limited range of health care services performed by providers participating in the plan."
(http://docs.legis.wisconsin.gov/statutes/statutes/609/01/3)


I suggest you to email the Attorney General of Wisconsin. (http://www.doj.state.wi.us/ag/)


Or better yet give the Wisconsin Insurance Commissioner a call:
OCI (Office of the Commissioner of Insurance)
1-800-236-8517, (608) 266-0103
•All questions and/or complaints regarding insurance companies and policies
(http://www.doj.state.wi.us/ag/contact.asp)

Hope this helps.