Breast Reduction Surgery after partial mastectomy/umpectomy

dburrow4

My name is Dawn and I was diagnosed with Breast Cancer in 2009.  I just recently decided to go with reduction surgery to make my left breast more equal to my right and to fix the disfigurement from the breast cancer surgery.  My insurance company denied stating it was cosmetic and not significant enough of a disfigurement to require surgery.  What are my options and why are they not similar to those for mastectomy.  I find this quite appalling that someone gets to decide what is disfiguring and whether or not it should be repaired...IT WAS BREAST CANCER FOR GODS SAKES!

traycal

Hi Dawn

The law states that insurance is required to pay even when its a partial mastectomy, especially if cancer is detected. I am not sure why your company is giving you the run around. It's the law!

-Traycal

mrsnjband

It is federal law that they have to pay, talk to your doctors office and have them re-process the claim.  I think they like to drag their feet. Mine tends to take their sweet time in paying but they do in the end. Sometimes the right hand doesn't have a clue as to the left.  NJ

lhasamom

It is against the law to deny coverage for this!!!  Who's your insurance co?  Do you have a nurse practicioner who can be your advocate?  Is there a cancer department at your hospital?  Check with them and ask, they can help you with this.  If you haven't already, keep track of EVERYONE you speak with, name, date, time, and the result of the call.  Call your insurance company, and when you finally get a human, start by saying, "I really need your help", this goes a long way, it makes them feel needed.  (Believe me, I've spent MANY HOURS on the phone with insurance companies) Once you've put them in the position of helping you, instead of answering a call from an irate person, their whole attitude changes.  If you're dealing with a denial of coverage, write a letter to the grievence department, explaining EVERYTHING that has happened so far, and end by saying you believe the procedure is covered under federal law that was passed.  Hope this helps some.  Keep us updated on your situation!

Lynn