Lumpectomy- Had in 2013

brooke18

I am looking for any help with getting my insurance company to stop denying me my reconstruction. I was told in the begining that it was covered by a Womens law. And they keep on denying me? Please HELP

SpecialK

The WHCRA covers reconstruction for mastectomy, but reconstruction after lumpectomy is not specified in the law passed in 1998. Some states have since enacted legislation that covers reconstruction after lumpectomy, but I don't believe it is widespread. There are some folks that have argued that lumpectomy is "partial mastectomy" but I think that insurance companies have some leeway with that interpretation, and it also may depend on how much tissue was removed from what size breast. Some patients have had success in getting oncoplasty covered - corrective plastic surgery done at the time of lumpectomy, but it can be an uphill battle to get reconstruction done at a later date. Has your breast or plastic surgeon appealed to your insurance company with a description and photos indicating what needs correcting, perhaps with information about what type of corrective surgery needs to be done?

brooke18

Yes, it was coded 19301. I had 3 biopsies before the lumpectomy. The mass at time of complete removal was 4cm. It left the nipple on my right really high and disfigured do to not have much breast to begin with. at this time I wear two breast prosthesis one one each side to even it out. I just want to have some closure and wholeness back. Any advise or help would be appreciated. Thanks