insurance denied implants

beth75

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I was informed today my insurance denied my implants after my double mastectomy next month. Because I was diagnosed with dcis stage 0 they consider it cosmetic. I'm devestated and not sire what to do. Any opinions would be greatly appreciated

I_Spy

Good grief and I'm nearly in the same boat as you. Do you have any other high risk issues? Family history, genetic testing, etc? In other words, is there a reason you are doing a PBMX for one spot of DCIS? Usually the doctors (and insurance companies) start with a lumpectomy, unless there are other factors to consider. And if there ARE other factors to consider (that make you high risk for a recurrence or invasive cancer), you need to appeal the insurance company's decision, outlining those factors. Your doctor's office can help you with that appeal, and the doctor can write something. I don't think they are saying the implants are cosmetic as much as the PBMX is not medically necessary....? I mean, there are laws that if you are getting a mastectomy they HAVE to offer you reconstruction, so it makes me thing what they are really saying is you don't need a PBMX for DCIS, and that is what you have to appeal (if in fact it is medically necessary)

inks

If the insurance will pay for mastectomy then they have to pay for reconstruction, that's the law.

inks

kayb - I had no idea. That is just awful, so if one is old or low income and relies on government for the healthcare one might have to go boobless. I wonder if they would cover a prosthesis in this case?