Topic: Insurance and paying for reconstruction

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Posted on: Sep 17, 2010 05:48AM - edited Sep 17, 2010 05:53AM by nora_az

Posted on: Sep 17, 2010 05:48AM - edited Sep 17, 2010 05:53AM by nora_az

nora_az wrote:

I have BC/BS of Georgia PPO I am going to the Mayo for treatment. I had my first appointment yesterday and finally for the first time in 2 weeks I dont feel this impending doom around me and I feel positive about our game plan.

My surgeon/oncologist (dr from here on out) after reviewing all my medical info he had said I was a candidate for a lumpectomy/radiation. When I started talking to him about how with my family history would I be suitable for a double mastectomy with reconstruction (no implants I'd use my own fat) After taking extensively about my family history he agreed that I do have a very significant family history and it's only a choice I could make but it would greatly reduce my chances of having to go through this again. He told me I was not being over zealous for wanting to do this and he supported that decision if that's what I was mentally prepared for.  He told me I am at stage 1 right now and unless lymph nodes are involved which he hasnt a clue until we get in there it will stay at stage 1. 

My question is, will my insurance pay for a double mastectomy with reconstruction if it's more drastic than what surgeon said I was initially a candidate for?  I totally forgot to ask him this. Does he just code it in a way that I didnt have a choice or what?

I'm afraid to call the insurance company to ask them because I dont want my file flagged saying that he initially told me I was a candidate for a lumpectomy.

DIEP with nipple sparing mastectomy on 10/13/10 TCH started 11/26/10 Anastrozole started 4/7/11 Hysterectomy/ooph and VATS (lung) surgery 5/22/12 diagnosis Coccidioidomycosis, not metastasis to the lungs as they thought. Yeahhh Dx 9/3/2010, IDC, 1cm, Stage IIA, Grade 3, 2/17 nodes, ER+/PR+, HER2+
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Sep 17, 2010 05:59AM lago wrote:

I would think your surgeon's nurse could help you with this. I would be surprised if insurance didn't cover this.

DONE!! goo.gl/IoaN6U • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010 Dx 7/13/2010, IDC, 5cm, Stage IIB, Grade 3, 0/14 nodes, ER+/PR+, HER2-
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Sep 17, 2010 07:11AM nora_az wrote:

Thanks...I will call her this morning. I just really want to get this done and I dont what the insurance company to say they wont pay for it based off the fact that it's quite a bit more than what the surgeon said what I was a candidate for. (although he also said if this is what I was mentally prepared for I was a perfect candidate for the double mastectomy with reconstruction too)

DIEP with nipple sparing mastectomy on 10/13/10 TCH started 11/26/10 Anastrozole started 4/7/11 Hysterectomy/ooph and VATS (lung) surgery 5/22/12 diagnosis Coccidioidomycosis, not metastasis to the lungs as they thought. Yeahhh Dx 9/3/2010, IDC, 1cm, Stage IIA, Grade 3, 2/17 nodes, ER+/PR+, HER2+

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