Topic: Disability denied after reconstructive surgery

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Posted on: Sep 13, 2010 10:02PM - edited Sep 13, 2010 10:03PM by caringhija

Posted on: Sep 13, 2010 10:02PM - edited Sep 13, 2010 10:03PM by caringhija

caringhija wrote:

My mom had a mastectomy last year. She was out of work from Sept to mid-Jan (due to chemo). She started working again her regular hours. She has worked in the same small office for 10yrs. Everyone knew she was going to be having reconstructive surgery. Even gave her the day before off.

About 1 week after her surgery when she called and told them the Dr gave her 1 month time for recovery, she was told by their HR person that the surgery was covered by the insurance but because her surgery was an elective that they wouldn't cover disability. In the form they eventually gave her 'elective' wasn't mentioned- just that it wasn't covered by lack of hours worked (min of 1500).  

She's fine financially- sort of. She's upset and will be retiring next year (whole lot of other questions for that) but for now... it just sounds so fishy to me. Can they really do this? She's in CA if that makes any kind of a difference. 

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Sep 13, 2010 10:09PM rcca wrote:

If her company won't cover her she can get CA short-term disability (tax free!)

Dx 3/22/2010, IDC, Right, 1cm, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Sep 14, 2010 06:37AM - edited Sep 14, 2010 06:38AM by dreaming

Cosmetic is elective not reconstructive, there are some Federal Regulations that we advocates fought for, when I was diagnosed a long time ago, it was up to the Insurance to pay for it, now they have too if one wants, this is the difference with "elective ".

After the mastectomy a second diferent cancer was found: Invasive Ductal Carcinoma, C.F.M.: Dx 7/7/1991, ILC, Right, 1cm, Stage IA, Grade 1, 0/18 nodes, ER+/PR+, HER2-
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Sep 16, 2010 12:32AM lauri wrote:

CA SDI is covered by the state, not by the company.  Was this a company-sponsored disabilty insurance ?  (Pay stub showing CA-SDI would indicate state plan)  Check EDD.ca.gov

Will she be Medicare-eligible (age 65) when she retires ?  If not, she might want to reconsider the cost of interim health insurance.  And be prepared for the cost of medigap insurance.

From the ashes of disaster grow the roses of success Dx 3/8/2006, ILC, Left, 6cm+, Stage IIIB, metastasized to bone, Grade 2, 11/12 nodes, ER+/PR+, HER2- Dx 11/15/2021, ILC, Stage IV, metastasized to bone Hormonal Therapy 11/28/2021 Femara (letrozole) Targeted Therapy 12/2/2021 Ibrance (palbociclib) Radiation Therapy Whole breast: Breast Surgery Mastectomy: Left Chemotherapy AC + T (Taxol) Hormonal Therapy Arimidex (anastrozole)

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