NOLA in September?
Comments
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Ladybug, that stinks! I am so sorry. Lucky the stage 1 is over with. Stage 2 is cosmetic anyway, so I would think local is reasonable now. I am sure you want it over with. Changes in insurance are such a pain...
Laurie, thanks for that link! All, it looks like you need to pay 2.99 for the podcast, but you can actually just play it right there on the website... I have not listened yet, but have it all loaded!
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Ok, all you wonderful women, all my sisters- what do you think?
There was no fee when I heard this audio file on my computer. The second half of the audio file tells about BC. Perhaps we could get a dialogue going regarding this broadcast. Would love to hear other womens opinions.
http://www.peoplespharmacy.com/2010/11/13/791-hormones-breast-cancer-and-bones/
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ladybug,
I understand how frustrated you must feel. You had this all figured out then bam, everything is thrown out of wack. However, I am glad NOLA is really looking after your well being. Sounds like they may be trying to avoid potential problems that could occur. Your safety is most important, more than anything.
Laurie
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Well, I just got word from the Center that the insurance company has denied any revisions to my breasts. Can you believe this Bullsh*t? This is after they have received information, doctor's notes, etc. from Dr. Sullivan? Unbelievable. I don't know what to do now. I know they said I can appeal this denial, but really... what more can Dr. S say that he hasn't already? Unbelievable. Anyway, that is where we stand.
Ladybug - I am sorry to hear about your stage 2 cancelation. I know how frustrating that is. I hope you get your clotting under control and can move forward from there.
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Nordy~ that is a bunch of bull crap (I tamed it down some). I hope that NOLA can help you so you can get the revisions.
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Thanks Jaimieh. I just talked to the Center. They sent everything that the insurance company requested and I was still denied. Now it is up to me to fight them on this. I am going to try, but I think it is going to be a hard fight. AND my insurance company only allows 2 appeals, so if I don't get it right the first time, I am going to have to live with things as they are, OR I am going to have to pay 100% out of pocket for revisions. I wish I could say that I didn't think this would happen, but I knew it would. BUT, if I was having revisions with the doctor affiliated with the hospital, I would bet that it would have been covered. (He is an employee of the hospital and the hospital is self insured - so at least 50% of what would get paid out would go right back to the hospital...) Here we go...
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Well it seems to never end for me. My incision on my hip (last drain to go) is swelling and getting a bit red. Actually it is not the incision as much as around it. Laura said it was fluid accumilation and to put more compression on it. Has this happened to anyone before? Would more exercise help or hurt. She said they could arrange to have it aspirated locally if it does not get better. OUCH!! It hurts to think about it.
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Melinda... I don't know if I should tell you my drain story! I had to have multiple aspirations after my drains were out, then my local PS just put 2 very small drains back in to allow that cavity to close up. Aspiration is not difficult - just a pain to have to keep going to the doctor's office! Definitely more compression is better, and actually, less activity is better. SO... hang in there!
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Thanks Nordy, Sure wish Dr. D was not so far away. I just don't feel real comfortable going to local hospitals or doctors.
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Nordy, that is ridiculous. But I'm afraid it's the way things are going to be--and "Obmam Care" can't be blamed yet.
You're going to have to write the most fact-laden, emotionless appeal letter of your life.
I just went through this with my insurance company who denied my C-Spine MRI but allowed the epidural steroid injection. We'll see what happens. I had to have the MRI before my pain specialist would put a needle in my neck...
The usual routes of cc'ing copies to your congressman and Insurance Commission apply.
Probably the "big" question is not whether tweaks are needed, but is plication a necessary procedure as opposed to an elective one. There seems to be no standard of care between insurance companies.
Best of luck getting what you need.
Anne
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((((((((((Nordy)))))))))) I am so sorry. Just take a deep breath and let em have it! It is so frustrating that we go through all we do, then have to go thru more just to get back some semblance of normal! You are in my prayers, lady... Good luck!
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Thanks Anne. I just don't know if I have it in me to fight this fight. I don't really care about the plication - if I really want it I can have it done locally. I personally just think it will help with the recurring hernia issue. The real issue here is the asymmetry in my breasts - not horrible - I do look pretty good, but the right one is definitely a little wider and has more volume than the other. Funny thing is when I spoke to HR a couple weeks ago and said I was a little uneven, their answer was, "well who isn't?" Well, I WASN"T prior to BC. I didn't choose this path, it chose me and now I have to beat down another door to get it covered. Ridiculous.
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Thank you Gin
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Nordy, I am sorry. Are you going to fight the insurance company? Hang in there. I am sorry because it sounds like STRESS for you and we just don't need more stress. None of us do!
Melinda, ouch. Did they put you back on antibiotics??
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Nordy, I would defintely NOT mention plication (or lipo) in your appeal. Stick to your right to have revisions for symmetry. Send the most asymmetrical photo you can take, and show how it affects the way your clothes hang, the way your bra fits, etc. I appealed twice on my stage I, and the second time, it worked beautlfully. My ins. company had told me before surgery that about $7500 would be covered, and I was actually appealing for payment to the co-surgeon but miraculously, they paid over $20,000. I ended up not owing my first surgeon a dime after my initial payment of $2500, which I felt really good about since he did such a lousy job--including accidentally burning a hole in my chest and all of the other things that went wrong. I think you'll prevail, but they will make you jump through some hoops first. Remember, an insurance representative's job is to NOT pay claims. Go get what is rightfully yours, Nordy!!!!
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Boy, I'm pages behind! I'm not even going to try to read more than this page.
Spring - Actually it hardly snowed at all here - just a nice dusting and then most of it melted. Where they got the crazy snow was down by Dejaboo!
Ladybug - Wow! What an unbelievably frustrating situation! So sorry things got so screwed up, but the most important thing is your health - just keep telling yourself that as you fume...
Nordy - Keep trying! They want you to quit! They hope you quit right now! (Listen to Sandy). So much for leaving medical decisions up to the patient and her doctor! Ha! The insurance companies make the decisions - and Anne, you know I agree with you - t'ain't "Obama-care's" fault, 'tis not enough regulation of insurance companies, IMHO.
Melinda - Sorry you're dealing with that extra fluid. I had a little bit of it with my first recon. Do what Nordy tells you to do, but if you end up needing aspiration, mine didn't hurt one bit.
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Heading to the airport ladies!!! Hoping to meet the 3 other ladies that are there at the Hope Lodge/NOLA!!
Nerves are really kicking in, stomach feels off!! Could be a fun flight.0 -
Carroll and Laurie,
I finally am listening to the pod cast you both recommend by Dr. Susan Love. Very interesting. My take away: Keep EXERCISING! Eat a PLANT BASED DIET! Employ SERENITY PRACTICES like YOGA! I am gong to keep doing this. Apparently the thought is that it can prevent Breast Cancer recurances by changing the environment in your body to be hostile to cancer. (This is the same philosophy as in Anti-Cancer, A New Way of Life). Here is the ULR again for those who are interested. http://www.peoplespharmacy.com/2010/11/13/791-hormones-breast-cancer-and-bones/ What she says about hormones makes sense too, I was surprised that even bioidentical hormones are risky... hmmm. But the fact that the body reduces hormones on it's own (aka, menopause is built into us) sort of makes sense to me, that this is perhaps a protective mechanism...
DRAGON!! YOU GO GIRL!! Check in when you can! Let us know what's up...
DBDAZE - we are thinking of you TODAY!!
- Nov 16 - Dbdaze - Stage 1, Dr. S., NOLA.
- Nov 18 - Dragonfly1976 - Stage 2, Dr. S., NOLA
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Yes! Good luck to you, Dragon! (I love the nickname of the nickname!) Send our best to the other NOLA gals, too. Be sure to have some fun before your surgery!
And good luck to you, too, DBDaze - perhaps you are already sleeping away blissfully, while we write!
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Nordy, I agree with Sandy that you are entitled--by law--to have adequate reconstruction, and that means symmetry. Don't mention the other stuff. (On my requests for auths, though, the lipo and fat grafting are included with ICD codes to ensure payment.)
Sometimes you just have to be a bit of a squeaky wheel. I was able to get my MRI approved with the info I had that my doctor's office didn't. But it is so stressful and frustrating.
I'll bet you get it okay'd in the end. But it may taking jumping through so many hoops you feel like a border collie!
Anne
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Just got off the phone with the US Dept. of Labor (since my husband's employer is self insured, they are the governing authority on our health plan). They are sending me info regarding the Women's Health and Cancer Rights Act. They also said that ALL stages of reconstruction are to be covered and that is supposed to be between the attending MD and the patient (ME!). She also said that if I continue to have problems that I am to call her directly. Now... I hope it doesn't come to that because my hubby can't afford to lose his job over this (I know that is not supposed to happen, but we all know it does)... I think that is where our insurance company strong arms everyone...
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Here's the pertinent part of the law:
SEC. 713. REQUIRED COVERAGE FOR RECONSTRUCTIVE SURGERY FOLLOWING MASTECTOMIES.
(a) IN GENERAL.- A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, that provides medical and surgical benefits with respect to a mastectomy shall provide, in a case of a participant or beneficiary who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy, coverage for-
(1) reconstruction of the breast on which the mastectomy has been performed;
(2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and
(3) prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the patient. Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the plan or coverage. Written notice of the availability of such coverage shall be delivered to the participant upon enrollment and annually thereafter.
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Hi Ladies,
I made it home today (1 day late). We were stuck overnight in Las vegas due to fog in San Diego. I am so tired and swollen. Stage 2 went great. Dr S was able to make my breasts about the same size and he even added my left nipple at my post op on Monday. I had my ovaries removed and complete ab plication along with lipo on my back fat and legs. I was so swollen on Saturday that my eyes were even puffy. I am so glad to be home.
I could only post once at Hope Lodge because there were kids there (who were not there due to treatment) using the computers all of the time. It seems there is a group of people who are either volunteers, staff or who also volunteer and have a child there during treatment, who have decided to make the Hope Lodge their community center. They also had 3 healthy kids there frequently and children are not allowed unless they are in treatment, due to the germ factor.
The group of people were noisy, took over the stoves and the tvs and computers at least twice in the evenings while I was there and made the noise unbearable. It was so bad on Sunday night that children were running around with punch balls hitting them and dragging toys across the floor while the adults were either yelling during the football game on the big screen tv or eating and laughing it up in the library. We could not carry on a conversation in the dining hall and I went to complain but there were kids at the front desk playing on the computer. I have contacted the woman who is the boss of the director at Hope Lodge and will definately register a compliant.
Otherwise, we had a great time. We went on the swamp tour, took a mule carriage tour and toured the cathedral. The Cathedral was absolutely beautiful and the people of New Orleans were friendly and helpful.
Just a quick story for your enjoyment. While Dr. S was adding my left nipple, I asked him "So, what do men think about these nipples?" and Dr S with a big smile on his face said, "They love em....I have four nipples on my back right now". Of course that was not what I meant but, I had to hold my gut because I was laughing so hard....
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Nordy, I feel for you over the insurance issues. Mine has put me through H*ll..My company is also self insured but Cigna is the administrator. Is the Dept of Labor in charge of all self insured companies policies? Keep fighting and keep us posted.
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Lynn,
I'm so sorry you had all that bedlam at Hope Lodge. For sure file a complaint! One other thing I heard is that, tho the place is supposed to be non-denominational, there was definitely an element living there that is pushing an agenda. Wow that your breasts are now symetrical and that Dr. S gave you a nipple at post-op! Whaaaat?! Tell us about that! Did he just do it in the office? In the operating room? Were you under local anesthesia? Give us details! Could you see him making it? What did you see? That is hilarious what you asked and how he answered!
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Nov 16 - Dbdaze - Stage 1, Dr. S., NOLA.
Nov 18 - Dragonfly1976 - Stage 2, Dr. S., NOLA
SENDING POSITIVE VIBES YOUR WAY.
LAURIE
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So glad to see all doing so well! And good luck to those coming up... Hang in there, Nordy... Just pulled my last drain! Yay! This time has gone sooooo much better than any of my other surgeries.... Maybe things are finally getting straightened out!
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sheridangirl-
About your comment-
Just a quick story for your enjoyment. While Dr. S was adding my left nipple, I asked him "So, what do men think about these nipples?" and Dr S with a big smile on his face said, "They love em....I have four nipples on my back right now". Of course that was not what I meant but, I had to hold my gut because I was laughing so hard....
It gave me a big smile. Haven't smiled for a while. It felt good.
Laurie
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I'm hoping to check on Dbdaze tomorrow when I'm there for post-op but we'll see if she's up for it!! Here at the hope lodge, safe and sound
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A nipple right there in the OFFICE?? Well, this IS a new one! Do tell! The swelling will go down, though you feel like a human marshmellow at the moment, it will not be forever! Hang in there!
4 nipples on his back. ha ha ha ha ha!!
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