surgery

bakerette · July 2010

Hi,
I have a strange situation. First, I had my first mamogram in April.Then I had a biopsy. Then the next day they told me I had very little very early cancer. Then I was assigned a surgeon. She said a lumpectomy would do it and just to be sure lets do an MRI. Well, that showed two more suspicious spots and then I had the MRI guided biopsy. Yep, more Cancer. Only in right breast. Still small very early but comedo, very aggressive, hormone negative. Well, since it's multifocal the lumpectomy is out of the question a mastectomy is the standard. My surgeon wants me to have bilateral and considering it is agressive and hormone negative I agree. So, I was all set to have the bilateral mastectomy with immediate reconstruction. This is to happen this Friday the 16th. Now, I get a letter from my insurance that says they will not pay for the left breast and though they agree with the right breast mastectomy they will not guarantee payment of that for sure either. What the heck? My surgeon says she will not let this drop and so now they are in this big tug a war with me in the middle. My surgery is coming up this week and I do not know what is going to happen. I'm nervous. Will I wake up with one or none? The suspense is killing me.

AMomNETN · July 2010

So Sorry
I'm so sorry you are having to go through this. It isn't easy in the best of circumstances. I'm not sure your insurance can deny to pay for your surgery and reconstruction. I think it is against the law now. I may be wrong but I think it is Federal Law. I hope you get answers soon. I know insurance it madding. What was their reasons for dening payment? Like I said I don't think they can do it. Good Luck and keep us posted.

Janie

Ladymom · July 2010

surgery
If you haven't already call your insurance company and ask them why they won't authorize the surgery. Keep a record of who you talked to, the time, and what they said. Be respectful but assertive. Would they like a second opinion and would they pay for it? I know dealing with cancer is enough of a drain on your emotional resources without having to fight for treatment. Do you have a spouse or some advocate that could do the calling for you? In one of my insurance nightmares I had my husband deal with the hospital and insurance company. To my great relief everything got solved. For minor things the insurance works well but for major things the red tape gets tied in knots and my husband or I have to work very hard to untangle them.

bakerette · July 2010

Ladymom said:
surgery
If you haven't already call your insurance company and ask them why they won't authorize the surgery. Keep a record of who you talked to, the time, and what they said. Be respectful but assertive. Would they like a second opinion and would they pay for it? I know dealing with cancer is enough of a drain on your emotional resources without having to fight for treatment. Do you have a spouse or some advocate that could do the calling for you? In one of my insurance nightmares I had my husband deal with the hospital and insurance company. To my great relief everything got solved. For minor things the insurance works well but for major things the red tape gets tied in knots and my husband or I have to work very hard to untangle them.

surgery
The Insurance company's reasoning is that since I only have cancer in the right breast there is no reason to take the left. Even though I believe and so does the surgeon, that a bilateral is the best way to assure nonrecurrence, the insurance company doesn't feel that we have proved medical necessity. I don't understand these people. Since I have very dense breast tissue, that means they will be paying for an MRI every 6 monthes for a long while, I believe 5 years. That is very expensive for them.

Sally5 · July 2010

bakerette said:
surgery
The Insurance company's reasoning is that since I only have cancer in the right breast there is no reason to take the left. Even though I believe and so does the surgeon, that a bilateral is the best way to assure nonrecurrence, the insurance company doesn't feel that we have proved medical necessity. I don't understand these people. Since I have very dense breast tissue, that means they will be paying for an MRI every 6 monthes for a long while, I believe 5 years. That is very expensive for them.

Bakerette
Hi Bakerette,
I was diagnosed with breast cancer (on the right breast) but I had a bilateral mastectomy. (A lot of family history and worry)

My oncologist said it was my choice. He said my insurance would cover it even if I elected to do one now and one later... I do think it is a law.

Don't give up... Our fight is with cancer. It shouldn't be with our insurance company.

lolad · July 2010

bakerette said:
surgery
The Insurance company's reasoning is that since I only have cancer in the right breast there is no reason to take the left. Even though I believe and so does the surgeon, that a bilateral is the best way to assure nonrecurrence, the insurance company doesn't feel that we have proved medical necessity. I don't understand these people. Since I have very dense breast tissue, that means they will be paying for an MRI every 6 monthes for a long while, I believe 5 years. That is very expensive for them.

Fight it
Like others that have made comments to your post. It is the law now that reconstruction has to be covered and paid for by the insurance company. I cant stand these darn insurance companies when they think they can fight on paying something that has to do with a serious illness. Have your doctor put in medical codes and words that would require the stupid jerks to pay then. But like i said, im almost possitive, law is, they have to pay. Tell them to let them be in your shoes, bet it get paid then!! Boy, im am on a big role tonight!! Sorry,
take care
laura

surgery

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