Posted on: Aug 20, 2007 11:31PM
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Posts 1 - 20 (20 total)
Aug 21, 2007 01:01PM sharebear wrote:In Michigan insurance companies are required by law to cover any reconstruction issues pertaining to breast cancer. I had radiation after a lumpectomy and years later that breast had shrunk is size about 40% which can happen after radiation. The insurance company paid for an implant in the radiated side and a reduction on the good size in order to create symetry. All in all it took about 3 reconstructions and implant swaps to fix everything. My breasts were so dense when I was diagnosed and the natural progression of getting older plus the radiation made it necessary to exchange the implants a few times for symetry. The first one capsulized which is why we decided to do the reduction and go for a smaller implant.
Aug 21, 2007 04:11PM Fit999 wrote:There was a national act passed in 1998 that requires any insurance company that covers mastectomies to cover all surgeries required for symmetry. My GS said that insurance will also cover me in the future when my natural boob sags and the implant is still high and perky. One funny thing, during my first post op checkup w/my PS she handed me the warranty card for the implant. She said since it was cancer related it�s a lifetime warranty. I read the fine print and the warranty only pertains if the implant breaks. And the manufacturer will pay up to a certain amount toward the surgery required to replace the broken implant, but the new implant would be free. Hopefully none of us will ever have to walk that road, but its good to know all the facts.
Aug 21, 2007 04:15PM Fit999 wrote:Dotti,
Aug 21, 2007 06:55PM iodine wrote:My first outcome was awful. The expander was encapsulated and never fully expanded but the ps would not admit it. I was a wuss and did't fight him, I also didn't pick him. He said he could fix everything with the exchange. The implant was under my arm, below the inframammy fold and 2 cups Smaller. He also "lifted" my good boob and made it a cup smaller to gain "symmentry".
Aug 21, 2007 09:13PM GoodMommy wrote:
I have a question re. insurance and hope someone can answer. I'm currently with UHC through my husband's employer (he's retired). My husband is 9 years older than me and will be medicare eligible in November. In order for me to keep my insurance, he has to buy a medicare supplement offered by UHC from his former employer. This is a rip-off because he will have to pay 2 1/2 times what he could get the insurance for on the open market. I can change to a different policy through his employer because there is no pre-existing condition clause. My question, I still have to go through the exchange and nipple reconstruction. Would that be covered by a different insurance company and also would the BC be considered a pre-existing condition if God forbids, there is a recurrence?
Aug 22, 2007 04:01PM sharebear wrote:I only know what is true in Michigan. I have changed insurance throught the years and through my reconstructions. We have a law that states as long as you continually have insurance and do not allow it to lapse, you do not have a pre-existing condition. If that means paying for cobra when changing jobs and waiting for insurance to kick in that that's what I've done and I've always been covered. Just don't ever go without.
Aug 22, 2007 04:02PM GoodMommy wrote:Shannon,
Aug 23, 2007 01:02AM memee146 wrote:This is a concern for me also, my Husband is having issues with his job and I am in the middle of reconstruction. He is trying to deal with it at least until I finish recon.
Aug 23, 2007 12:04PM Melanie53 wrote:My Continuation of Coverage (similar to Cobra but only available for six months) will end on Sept. 30. My husband works for a small company (three employees), and I have no benefits where I work.
Aug 23, 2007 12:15PM sharebear wrote:Just a thought and a terrible one it is.If you decide to play the six month pre-existing condition weighting game, what if it's not a reconstruction issue and what if something comes up cancer related during those six months? That could be catastrophic. Not something we want to have to think about but definitely a concern in our world now.
Aug 23, 2007 12:32PM ijl wrote:I found this link which describes pre-exsiting condition policy for most of the states. For CA it looks like as long as one has un-interrupted policy , i.e. switching from one to another, there is no waiting period for pre existing condition
Aug 23, 2007 12:37PM Melanie53 wrote:
Just a thought and a terrible one it is.If you decide to play the six month pre-existing condition weighting game, what if it's not a reconstruction issue and what if something comes up cancer related during those six months? That could be catastrophic. Not something we want to have to think about but definitely a concern in our world now.
Aug 23, 2007 12:54PM kathy8429 wrote:I would think any group helath policy would have to cover. Here is the wording of the law
Aug 23, 2007 01:01PM Melanie53 wrote:
I would think any group helath policy would have to cover. Here is the wording of the law
On October 21, 1998 Congress passed a bill called the Women's Health and Cancer Rights Act of 1998. This law requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services. These services include:
Reconstruction of the breast upon which the mastectomy was performed,
Surgery/reconstruction of the other breast to produce a symmetrical appearance,
Physical complications during all stages of mastectomy, including lymphedemas.
In addition, the plan may not:
Interfere with a women's rights under the plan to avoid these requirements, or
Offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with the requirements of the law.
However, the plan may apply deductibles and copayments consistent with other coverage provided by the plan.
Aug 23, 2007 04:51PM slanderson wrote:Chris,
Aug 23, 2007 04:55PM lvtwoqlt wrote:I know that after my first lumpectomy for ADH that changed the shape of my left breast from a C-cup to an A-cup, the insurance paied for prostesis and bras to even out my breasts. this year I was dx with DCIS and the insurance is paying for the reconstruction after bi-lat mast.
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