Ins change in the middle of recon!! Need advice!!!!!

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Fearless_One
Fearless_One Member Posts: 3,300
edited June 2014 in Employment, Insurance, and Other Financial Issues

My PS that I am thrilled with is not on our company's new plan.   However, it doesn't take effect until 12/1.   My exchange is scheduled for 11/11, so that's okay. 

What about the nipple recon??   How does the law work if your insurance changes??   Or should I get the nippled recon done with my exhange surgery?   Please help - any advice welcome!!!!

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  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited October 2011

    bump :-(     

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  • peggy_j
    peggy_j Member Posts: 1,700
    edited October 2011

    Arg! Sorry to hear you're going through this.

    I can see why you'd want to stick w/ your PS that you love. But...what about follow up visits? (there will probably be one at one month, and in the future). And of course, if you have questions or issues that come up, who will you see? Will he/she recommend another surgeon who takes your insurance? Would be nice to have some continuity or common philosophy.

    But if you want to stick with him/her can you move up your surgery so you can have your 1-month follow up with him? Does the surgeon take your insurance but is considered "out of network?" Would your PS be willing to work with you? Maybe charge you the network-negotiated rate for your old insurance???? (the worrier in me does wonder why your doc isn't in-network for your new insurance. Maybe the reimbursement rate is lower or ?)

    Or another option: search for a new PS now and have them do the surgery and all the follow up. I would hate the idea of being in limbo. i.e. Having one surgeon do the work but having to see someone else if there are issues. Good luck.

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  • perky
    perky Member Posts: 241
    edited October 2011

    I believe you can negotiate with your provider to make an exception since you are in the middle of treatment. Wishing you the best.

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  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited October 2011

    Thanks, ladies - I just can't believe it.   I have a call into his office, so we'll see what happens.   I will def have my exchange with him next month.

    My concern is that the new insurance will not cover nipple recon since they were not the ones that covered my mastectomy. 

    I need ALL new doctors - new onc, new PS, new Primary......I am so upset.....crappy new insurance.....

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