Reconstruction and Insurance

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DonnaJean
DonnaJean Member Posts: 1
edited March 2014 in Breast Cancer #1
I'm new to this forum. I was diagnosed June 3rd and as of today I am 3 weeks post surgery (right breast mastectomy immediately followed by the intitial phase of reconstructive surgery utilizing a free tissue flap and an expander). I was referred to an excellent plastic surgeon whose practice centers around this type of procedure. He spent 8.5 hours on my initial surgery and, though, I am still slightly uncomfortable, I am mending extremely well. My query of the forum - this surgeon was severly undercompensated (they paid out just $2,500.00) by my PPO Insurance provider for his time and for his level of post surgery care - even though this provider is a major player in the industry - has anyone else experienced this same problem? Thanks in advance for replying.

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  • DeeNY711
    DeeNY711 Member Posts: 476 Member
    #2
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    The participating provider option creates a network of participating providers by whom agreement was reached to accept a discounted rate. Within the health care industry, the only people who pay full list prices are people with no insurance who pay their expenses out of pocket. Although there is always dialogue about what a fair and equitable discounted rate ought to be, the rates are based upon accepted current industry standard. While I share your vision that my own surgeon ought to be given the sun and the moon and the stars for what he has contributed toward my wellbeing, health care is a business operated under business protocols. I'm glad you are doing well, and my surgeon always tells me that his greatest reward is in seeing me do well. Hugs, Denise
  • DJC
    DJC Member Posts: 52
    #3
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    DeeNY711 said:

    The participating provider option creates a network of participating providers by whom agreement was reached to accept a discounted rate. Within the health care industry, the only people who pay full list prices are people with no insurance who pay their expenses out of pocket. Although there is always dialogue about what a fair and equitable discounted rate ought to be, the rates are based upon accepted current industry standard. While I share your vision that my own surgeon ought to be given the sun and the moon and the stars for what he has contributed toward my wellbeing, health care is a business operated under business protocols. I'm glad you are doing well, and my surgeon always tells me that his greatest reward is in seeing me do well. Hugs, Denise

    Denise-I'm using my other login to reply to your message-thank you for your words of encouragement and for your very eloquent and informative reply-I'm just starting this process and am trying not to become too overwhelmed by it all. Like your surgeon, my surgeon is first and foremost the consumate caregiver - and, although, I see the practical rationale in support of the limitations placed on certain reconstructive surgeries, I certainly wish these doctors who perform such life enhancing procedures were better compensated.

    I am starting chemotherapy this month (4 sessions spaced out at 21 day intervals) and now know what to expect for the most part due largely to having read the messages posted on this site. This site has become a lifeline and I am truly thankful for a resource of this type and for women like yourself who take the time to help those like me who are just embarking on our own paths to recovery. I'd be interested in sharing experiences with you and others - I can be reached at djcooper_99@hotmail.com. Best Wishes for your own progress and recovery. Donna
  • jake10
    jake10 Member Posts: 202
    #4
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    DJC said:

    Denise-I'm using my other login to reply to your message-thank you for your words of encouragement and for your very eloquent and informative reply-I'm just starting this process and am trying not to become too overwhelmed by it all. Like your surgeon, my surgeon is first and foremost the consumate caregiver - and, although, I see the practical rationale in support of the limitations placed on certain reconstructive surgeries, I certainly wish these doctors who perform such life enhancing procedures were better compensated.

    I am starting chemotherapy this month (4 sessions spaced out at 21 day intervals) and now know what to expect for the most part due largely to having read the messages posted on this site. This site has become a lifeline and I am truly thankful for a resource of this type and for women like yourself who take the time to help those like me who are just embarking on our own paths to recovery. I'd be interested in sharing experiences with you and others - I can be reached at djcooper_99@hotmail.com. Best Wishes for your own progress and recovery. Donna

    I was also amazed at the price my plastic surgeon was paid, very close to what yours was. Due to a complication with the abdominal site of my reconstruction I have be doctoring for the last 8 months with my plastic sureon and he has only recieved payment for an additional sugical procedure I needed to remove dead tissue in the abdomen. I have been in his office close to 130 times. Not a bad deal for $2300 bucks.
    You have come to the right place for help and wisdom. I did not know about this site until a few months after my diagnosis and surgery. I wish I had, but glad I found it anytime. Beth

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