AFLAC and PBMX?

I_Spy

Hi everyone -- does anyone else have AFLAC cancer coverage, and did they pay out on the PBMX and reconstruction? The claims examiner looking at mine seems to be an idiot in general, since I've had to ask for a review of things like days in the hospital (no, my PBMX was not an outpatient surgery, which if one looks at the docs I provided one would see), but they are digging their heels in on one aspect: They say that the DCIS I had last September in my right breast means that the MX of my right breast is covered for UMX and reconstruction. However, the left breast is considered "symmetry surgery", so I get $325 for that only, which is meant to include the MX and reconstruction since it is just being done to "match" the right breast.

I am high risk, my mother and her sister both died of bc, DCIS, ADH that grew in 6 months after LX, BARD1 gene mutation (similar to BRCA but studies are still being done on it), six biopsies and an LX, and my bs and I just decided it was time.

So anyone else run into this? and while we're at it, did they pay for nipple tattoos?

Beatmon

It must be because you had at separate times that they are dragging their heels. You could ask if they pay out when a bilateral is done when there is known cancer in only one breast. You should get paid for hospital days and the anesthesia reimbursement regardless. I can understand why they wouldn't pay out for cancer, but everything else should be covered. Have you had your representative call them? They should be able to go to bat for you. I'm interested to hear about coverage for nipple tattoo. I don't see anything on my information sheets that mentions that.

I wait about a week after my chemo, go to the hospital for the documentation( pain in the butt) upload it and get paid in 24 hrs. Imagine....getting paid to go to chemo....and graham crackers and a warm blanket.

All kidding aside, good luck with your reimbursement. I have certainly been glad that I kept mine when our company sold

I_Spy

Thank you beatmon. They are actually saying that the known cancer in my right breast is all they are paying for; in other words, the right breast is the "diseased breast" and the left breast is the "non diseased breast" so the left one I only get "symmetry" coverage for. I'm too tired to fight about it right now; at least they are finally paying for the hospital days.

lrash1167

I had a PBMX and then pathology found LCIS - I do have an AFLAC cancer policy... does anyone know if they will pay out for it and all my reconstruction surgeries?

I_Spy

actually they paid for the left breast once I submitted the path report that showed LCIS. Keep in mind they turned it down at first and I had to call. I think they have lower level employees reviewing thugs and they miss stuff. All together I had to call like five times to get the complete pay out, but I got it and they were always polite.