Topic: Plastic Surgeon recommendation, NYC?

Forum: Breast Reconstruction — Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Apr 25, 2022 06:39PM - edited Apr 25, 2022 06:42PM by meredithjane

Posted on: Apr 25, 2022 06:39PM - edited Apr 25, 2022 06:42PM by meredithjane

meredithjane wrote:

I am looking for a new plastic surgeon. I am actually at the follow-up stage with my current plastic surgeon. Unfortunately, he is out of network on my health insurance (which I did not know until after I first met with him), and that is creating all kinds of financial concerns. I can't take one more minute of those financial worries, and really need to find a new plastic surgeon. (If you are wondering why I have continued to see him until now, it is in large part because as unlikely as it seems, he has insisted, at great length, that I would not have to pay a penny for reconstruction treatment. But that doesn't help much when I get an EOB from my insurance company, as I did today, saying that I owe him $90,000 for reconstruction surgery; even if I never get a bill, this keeps me up at night with worry.)

One question I have, if anyone might know, is would a new surgeon be likely to take me on as a patient when I have already had my reconstruction surgery? I am not thrilled with how the surgery turned out and might want another surgery, but truth be told, I don't think I am up for that. So it is likely that a new surgeon would just be monitoring me on a post-surgery follow-up basis.

And the most important question: Can anyone recommend a good plastic surgeon in New York City? (He or she would need to be in-network on my insurance, United Healthcare. But this time, I will think to check that myself before starting treatment. So I am just looking for recommendations.)

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Apr 26, 2022 09:47PM jrnj wrote:

Meredith, I would think him telling you that you won't pay would help ease your mind, but I understand you are scared. I had a consultation with someone that said they would apply for an in-network exception, but I wasn't comfortable with that. She didn't promise me she wouldn't charge me. My Dr. is in network, and I haven't paid anything. But I also am not thrilled with my results (DIEP flap). A year later I had phase 2, didn't help much. Give it time and you'll be ready for a tweek. There is a DIEP flap support facebook page where you can search posts for Dr. recommendations, I have seen a lot, and I posted a request specific to Sloan Drs. that also work in NJ. But I was asking about DIEP. Do you have implants or other? After surgery and 2 follow-ups I don't follow up with my plastic again until I'm ready for more surgery, so they probably won't want to see you unless you are having a procedure.

Pleomorphic Multifocal, Extra nodal Extension, Lymphovascular Invasion. TEs removed due to infection Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Surgery 9/24/2019 Lymph node removal; Mastectomy; Mastectomy (Right); Prophylactic mastectomy; Prophylactic mastectomy (Left); Reconstruction (Left): Tissue Expander; Reconstruction (Right): Tissue Expander Chemotherapy 12/2/2019 CMF Radiation Therapy 3/30/2020 Whole breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 6/4/2020 Aromasin (exemestane) Hormonal Therapy 8/6/2020 Arimidex (anastrozole) Surgery 8/25/2020 Surgery 1/29/2021 Reconstruction (Left): DIEP flap; Reconstruction (Right): DIEP flap Hormonal Therapy 3/10/2021 Femara (letrozole)
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May 8, 2022 02:45PM meredithjane wrote:

It does help that he told me that he would not charge me for any of the breast reconstruction work. But I did get one bill for $855, related to one of the three surgeries I had last year. I asked him about it, and he said he would give it to his billing team to straighten out. That was on April 4, and I haven't heard anything. Meanwhile, the charge keeps showing up on MyChart. Oh, well. At least that is the only bill I have gotten from him (so far!).

I checked into the in-network exception, and unfortunately he is not eligible under my health insurance's rules.

Bottom line, even though he has promised I won't be charged, I wish I had gone with someone in-network, for peace of mind. (My primary care doctor, breast surgeon, and medical oncologist are all in-network. When my breast surgeon recommended this plastic surgeon, I just assumed he was in-network. I know I should have checked before treatment started, but I was struggling with everything else related to my breast cancer that I just didn't think to make sure. And again, I assumed that my breast surgeon would not recommend someone out-of-network without telling me.)

Anyway – I was supposed to have the DIEP surgery, but the day before, a cardiologist nixed it because he thought I had high cholesterol. That is a long, long story, but it is in the past. I have an implant instead. Which I am not thrilled with.

Thank you for your response! It is helpful. Best of luck on your reconstruction journey!

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