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Exchange City

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Comments

  • robinblessed54
    robinblessed54 Member Posts: 485
    edited February 2017

    eemaxx, I had my TEs in for 6 months which I was told is normal for my PS. 3 months to fill and 3 months to make sure pockets were stretched and settled. I was filled to 420 and have Allergan 410 gummies 475cc FF. I took 2 weeks off during spring break but could have gone back in a week. I too work at a school. I had similar restrictions as well for EX as BMX.

    Be good to yourself and your new foobs.

    "Just because you can doesn't mean you should "

    Robin


  • LRGO2016
    LRGO2016 Member Posts: 75
    edited February 2017

    Good morning ladies. 5 days post 2nd exchange of my right implant, and I'm completely off all pain management, not even tylenol. My single drain is slowing down rapidly too! My energy this time has been a bit low so I've been sleeping more the last 2 days, maybe that's why things seem to be improving rapidly.

    I recommend anyone undergoing exchange, plan for a week off, minimum! And the less you use or move your arms, the better!

    I am going to try to go to work (desk job) on Friday. One week post op. I'll let you know how I fare.

    Hope everyone is healing and feeling better!


  • trmtab
    trmtab Member Posts: 869
    edited February 2017

    well, to switch gears a little, wanted to share some good news ...

    as some of you might remember, I had to postpone by Dec 28th exchange as my mother had a stroke and is now living with us and recovering. Molly I feel for you in the new insurance/doctor business because when I had to miss my Dec 28th EX, I am now a summer EX!

    The good news is today I had my first "regularly scheduled" mammogram since this all started in Sept 2015...and I was given the all clear on my remaining R breast! When initially diagnosed, I had so many tests between Sept 2015 and Jan 2016, my MO wanted me to wait a year before another radiology test so that is why it is now...

    While I posted this on another board, I started Arimidex ahead of the L-MX...and the pathology at MX was that the DCIS area had shrunk...given the clear mammogram makes up for a lot of the aches and pains of the Arimidex side effects!
  • Molly50
    Molly50 Member Posts: 3,008
    edited February 2017

    Trmtab, how's your mom doing? Great news that the Arimidex is working! This whole thing about my exchange surgery is upsetting. I really am tired of the TE's. I will update once I figure out what I am going to do.

  • specialk
    specialk Member Posts: 9,261
    edited February 2017

    molly - most insurance companies will do a stat auth - the folks at your PS office (new one) need to get on the phone with your insurance and lean on them a little - which means you need to lean on the PS office. It is a little unfair for them to assume you can reschedule when they had to have known that they were making this move near the time of your surgery. They need to take your need for assistance and timing into consideration and ask your insurance company for a rapid approval. This is not a cosmetic procedure that has no timetable, so you should be able to jump the line.

  • Wildtulip
    Wildtulip Member Posts: 470
    edited February 2017

    Trmtab, Congrats on your mammo results!!

    Molly, I'm sorry you've had such a difficult week. I also have to be very strategic in my surgery planning, and if I were in your case I think I would go with current PS, and as SpecialK said, put pressure on to get insurance stuff in order. It's a risk, but it's good to stay with who you know.

  • LRGO2016
    LRGO2016 Member Posts: 75
    edited February 2017

    Good morning exchange sisters. How's everyone doing? I'm feeling good after the second exchange of the right squishy two weeks ago. This time around, the drain was pulled at my two week checkup! So much better than the previous two surgeries where my drains were in place for over 5 weeks!

    Does anyone know where to find information on the insurance rules that pertain to reconstruction following required mastectomy ?

    I was told by my oncologist that insurance companies are required to cover reconstruction and all subsequent related surgeries [including replacement or exchange after the 10 year life expectancy of the implants). But I have not found the details of this rule. I'm also wondering if this rule applies to Medicare? I'm worried about the costs of the surgery down the road, after I retire and am on a fixed income and either have limited insurance or Medicare only.

    Anyone have a lead on this info they can share?

    Lrgo


  • new__me
    new__me Member Posts: 53
    edited February 2017

    my PS told me everything is 100% covered. Even fat grafting if required. And subsequent implant exchanges as well if medically necessary. No time limit. The law was enacted in 1996 i think?

  • new__me
    new__me Member Posts: 53
    edited February 2017

    he also said if you change insurance carriers it doesn't make a difference with the law. I specifically asked about Medicare(i am almost 62) so will be eligible in 3 yrs. It is covered.

  • new__me
    new__me Member Posts: 53
    edited February 2017

    signed into law Oct 28, 1998

  • cateyz2
    cateyz2 Member Posts: 253
    edited February 2017

    I believe its called the Women's Healthcare Act

  • minustwo
    minustwo Member Posts: 13,356
    edited February 2017

    All those comments are correct - but LRGO might be talking about when our reconstruction/exchange implants might have to be replaced 10 or 15 or 20 years down the road??? I don't know that answer. Except I did see my PS last fall and he noted a difference in how they were hanging. He said "I can fix that for you". Other than the fact that I'm not excited about more surgery, it's 5-1/2 years since my exchange and he was indicating he could still fix it under Medicare. Interesting question.

  • Molly50
    Molly50 Member Posts: 3,008
    edited February 2017

    Hi ladies, I am tentatively scheduled for exchange on March 21st. I am very excited to have these TE's out. It's been way too long.

  • MrsB88
    MrsB88 Member Posts: 77
    edited February 2017

    Re: MASTECTOMY & BREAST RECONSTRUCTION INSURANCE COVERAGE

    This is my understanding of the insurance coverage for mastectomy reconstruction. It's a federally mandated law which requires ins. companies & medicare to cover the cost of mastectomy & mastectomy related surgeries including revision surgery if health related, i.e., capsular contracture, infection, implant failure & subsequent exchange of implants when they expire. It covers nipple & areola surgery & cost for a medical professional to tattoo areolas. I'm not sure if it covers 3D nipple tattooing by a medical professional. They don't cover the cost of the medical ink. They also don't cover areolas & 3D nipples created by tattoo artists. Hope this helps.


  • MrsB88
    MrsB88 Member Posts: 77
    edited February 2017

    Congrats Molly! I hope you are able to have your exchange surgery during the timeframe you requested with your original PS.

  • MrsB88
    MrsB88 Member Posts: 77
    edited February 2017

    Congrats Molly! I hope you are able to have your exchange surgery during the time frame you requested with your original PS. It has been way too long & you deserve to get rid of those uncomfortable TE's. Best wishes for an excellent outcome!

  • Molly50
    Molly50 Member Posts: 3,008
    edited February 2017

    Thank you, MrsB88. Just waiting for confirmation and a pre op appointment with PS.

  • Mominator
    Mominator Member Posts: 1,173
    edited February 2017

    LRGO, here are two fact sheets that should help answer your questions. If you need more information, there are links on both of these pages for more information.

    Mominator

    ===================================================================

    https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/whcra

    Fact Sheet: Women's Health and Cancer Rights Act

    U.S. Department of Labor
    Employee Benefits Security Administration

    The Women’s Health and Cancer Rights Act of 1998 (WHCRA) provides protections for individuals who elect breast reconstruction after a mastectomy. Under WHCRA, group health plans offering mastectomy coverage must provide coverage for certain services relating to the mastectomy, in a manner determined in consultation with the attending physician and the patient.

    The required coverage includes:

    • All stages of reconstruction of the breast on which the mastectomy was performed;
    • Surgery and reconstruction of the other breast to produce a symmetrical appearance;
    • Prostheses; and
    • Treatment of physical complications of the mastectomy, including lymphedema.

    Under WHCRA, mastectomy benefits may be subject to annual deductibles and coinsurance consistent with those established for other benefits under the plan or coverage.

    Group health plans, health insurance companies and HMOs covered by the law must provide written notification to individuals of the coverage required by WHCRA upon enrollment and annually thereafter.

    Additional consumer information on WHCRA is available in the publication Your Rights After A Mastectomy.

    Information for group health plans and employers on WHCRA and other health benefit law requirements is available in the publication Compliance Assistance Guide – Health Benefits Coverage Under Federal Law.

    ===================================================================

    https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/whcra_factsheet.html   

    The Center for Consumer Information & Insurance Oversight

    Women's Health and Cancer Rights Act (WHCRA)    

    The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy.

    If WHCRA applies to you and you are receiving benefits in connection with a mastectomy and you elect breast reconstruction, coverage must be provided for:

    • All stages of reconstruction of the breast on which the mastectomy has been performed;
    • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
    • Prostheses and treatment of physical complications of all stages of the mastectomy, including lymphedema.

    This law applies to two different types of coverage:

    1. Group health plans (provided by an employer or union);
    2. Individual health insurance policies (not based on employment).

    Group health plans can either be “insured” plans that purchase health insurance from a health insurance issuer, or “self-funded” plans that pay for coverage directly.  How they are regulated depends on whether they are sponsored by private employers, or state or local (“non-federal”) governmental employers.  Private group health plans are regulated by the Department of Labor.  State and local governmental plans, for purposes of WHCRA, are regulated by CMS.  If any group health plan buys insurance, the insurance itself is regulated by the State’s insurance department.  

    Contact your employer’s plan administrator to find out if your group coverage is insured or self-funded, to determine what entity or entities regulate your benefits.

    Health insurance sold to individuals (not through employment) is primarily regulated by State insurance departments.

    WHCRA requires group health plans and health insurance companies (including HMOs), to notify individuals regarding coverage required under the law. Notice  about the availability of these mastectomy-related benefits must be given:

    1. To participants and beneficiaries of a group health plan at the time of enrollment, and to policyholders at the time an individual health insurance policy is issued; and
    2. Annually to group health plan participants and beneficiaries, and to policyholders of individual policies.

    Contact your State's insurance department to find out whether additional state law protections apply to your coverage if you are in an insured group health plan or have individual (non-employment based) health insurance coverage.
    WHCRA does not apply to high risk pools since the pool is a means by which individuals obtain health coverage other than through health insurance policies or group health plans.

    WHCRA does NOT require group health plans or health insurance issuers to cover mastectomies in general. If a group health plan or health insurance issuer chooses to cover mastectomies, then the plan or issuer is generally subject to WHCRA requirements.

    Note: A non-Federal governmental employer that provides self-funded group health plan coverage to its employees (coverage that is not provided through an insurer) may elect to exempt its plan (opt out) from the requirements of WHCRA by following the “Procedures & Requirements for HIPAA Exemption Election” posted on the Self-Funded Non-Federal Governmental Plans webpage at http://cms.gov/cciio/resources/files/hipaa_exemption_election_instructions_04072011.html. This includes a requirement to issue a notice of opt-out to enrollees at the time of enrollment and on an annual basis.  For a list of plans that have opted out of WHCRA, go to http://cms.gov/cciio/resources/other/index.html#nonfed and click on “List of HIPAA Opt-out Elections for Self-funded Non-Federal Governmental Plans.”

    If you have concerns about your plan’s compliance with WHCRA, contact our help line at 1-877-267-2323 extension 6-1565 or at phig@cms.hhs.gov.


  • MrsB88
    MrsB88 Member Posts: 77
    edited February 2017

    Mominator - Thanks for the complete WHCRA by-laws!

  • LRGO2016
    LRGO2016 Member Posts: 75
    edited February 2017

    Thanks everyone for the information about the Women's health care law! Thus is exactly what I was looking for. Mominator, thanks especially for the detailed links and info. I'm not retirement age yet and medicare seems a long way off but by the time my implants need replacing, I will be relying on Medicare for my health care. I wanted to gather all this information and understand it well before I need it. THANKS, THANKS THANKS everyone!

    Molly50, good luck with your exchange! Implants are so much more comfortable than TE's.

    Be sure to follow your PS's orders during the healing period. I just had my right implant exchanged because it rotated and was hanging sideways. We don't know why it rotated but it is possible that I started working out too hard too soon after I was released to exercise or maybe I stopped sleeping in my sports bra too soon. I really don't want my new one moving around. So this time I'm taking it easier and will not begin any workouts for at least 4 or 5 months and this damn bra is not coming off for 6 mos! I'm so ready to move on to the nipple reconstruction phase and then tattoos. This delay is disappointing.





  • bluebirdgirl
    bluebirdgirl Member Posts: 11
    edited February 2017

    Molly50, I am also getting exchange surgery March 21st. Can't wait! Good luck to you.

    Mominator, thanks for the information!

  • Molly50
    Molly50 Member Posts: 3,008
    edited February 2017

    Hooray, surgery sisters Bluebirdgirl!

  • Artista928
    Artista928 Member Posts: 1,458
    edited February 2017

    I thought Medicare covers if the implants are uneven. Mine are but I have to wait 6 months. PS said any changes I want to be made is covered--doesn't have to be health or expired type of reasons. Is this not true?? I need my right foob to be lifted to be even with the left. It's noticeable.

    ETA: Looks like MC does?

    Medicare and breast reconstruction

    October 23rd, 2014 +2

    Thank you for your question. Yes, a bill passed in 1998 mandates insurance coverage for breast reconstruction. Additionally, it also covers any revisionary or balancing procedures on the opposite side to achieve symmetry.

    Matthew H. Steele, MD

    Matthew H. Steele, MD
    Sioux City Plastic Surgeon
    5.0 out of 5 stars 81 reviews

  • robinblessed54
    robinblessed54 Member Posts: 485
    edited February 2017

    Artista, where in CA are you? I noticed you are on Femara as well. How are you doing on it? I tried Arimidex and Aromison before I was put on Femara. So much better!

    Have a blessed day!

    Robin


  • Imkopy2
    Imkopy2 Member Posts: 214
    edited February 2017

    It's official I'm having exchange surgery on March 8th ( doing my happy dance) I absolutely adore my PS! Such a wonderful man, I told him March 8th it will be one year since I was officially diagnosed and he said I will make room for you don't you worry, we're going to change that date to a memorable one for positive things. Love him! Hope this post finds you all well

  • robinblessed54
    robinblessed54 Member Posts: 485
    edited February 2017

    Imkopy2, So happy for you! My exchange was in March also, 2 years ago. What kind of implants are you getting?

    Robin


  • Imkopy2
    Imkopy2 Member Posts: 214
    edited February 2017

    Thank you Robin! I am getting Natrelle round silicone but I'm not 100% certain if he will be using Natrelle 45 or the Inspiria. Either way I will be so happy to get rid of these expanders, I'm so over them! I can't remember exactly my fill size it's been so long, I believe I was filled to 375 or 425. I had necrotic tissue in the one side and somehow or another I lost track of my fill size. He completely drained the one side and we started from scratch doing the fills. I was lopsided for quite awhile. He will also be doing some FG I told him he is welcomed to remove as much fat from my abdomen he likes. I'm sure he hears that often

  • meg2016
    meg2016 Member Posts: 188
    edited February 2017

    Imkopy2- thats terrific! Did you have your TE's in when you did radiation? My BS won't do my exchange until 6 months after the end of radiation. I see her this week so I'm hoping we can discuss scheduling it, it would be great to have a date. I'm so ready to be done with these TE's. But waiting seems to be the biggest part of this journey. Good luck with your surgery! Hoping the result is amazing!

  • candles1
    candles1 Member Posts: 18
    edited February 2017

    Regarding insurance coverage for the cost of future reconstruction procedures, two important things to keep in mind:

    1. "Coverage" does not mean free. If you have insurance with a high out of pocket deductible or high out of pocket maximum, you could pay thousands for future procedures; and

    2. Laws change. We bc patients need to stay vigilant and make sure THIS law doesn't.

  • Imkopy2
    Imkopy2 Member Posts: 214
    edited February 2017

    Hi Meg! Yes I had radiation with my expanders in, that's the only way my PS would do it. My surgeon made sure I was expanded to the correct size before doing radiation because your skin can shrink. As for the waiting, yes BC truly tests your patience level, something I didn't have before all this that's for sure. My suregeon wanted to give my skin and body a chance to heal after radiation. He told me to schedule an appointment with him 3 months after I finished treatment so he could check out my skin to see if it was ready for surgery. Luckily he was very happy with the way my skin looked as feels confident I will have a good result. My friend however had to wait an additional 3 months though because he wanted more healing time for her skin. Im sure your surgeon wants to ensure you have the best results possible, let me know what she says. Thank you for your well wishes, crossing my fingers that your surgeon schedules your exchange soon, these expanders are a

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