going flat not covered by insurance?

ashell

Hi everyone!

Quick intro, had UMX several years ago with implant reconstruction, decided I didn't want implants anymore (have a small one in my remaining breast for symmetry). Finally decided I want to go flat.

Talked to my doctor, got her to refer me to PS, met with PS, she showed no hesitation to give me my wishes and let me go flat, was called in for a surgery date... but then had a death in the family, had to take a lot of time off of work, and it just didn't feel right to take more off for an "elective" surgery.

Of course, it is NEVER the right time to go under the knife. I decided it would probably be best for me to do it during my summer break so that I wouldn't have to take more time off of work. However, recently I've decided to switch jobs starting in July where I will have a year-round schedule. My insurance with the other job won't be quite as good, but still pretty good. I was thinking to plan a surgery for around October, as that seems to be the best time considering my lifestyle (I really enjoy skiing and swimming). All seemed ok in my mind, except I suddenly became concerned that by pushing back the surgery so many times, it will be looked at as elective/cosmetic and therefore not covered by insurance. I know I'm probably not speaking to insurance experts, but does anyone have any insight into this? Suggestions?

I hate my implants. I always feel them, they're uncomfortable and sometimes painful. I also think they could be negatively affecting my health. Sigh.

MelissaDallas

My guess is that for insurance to pay for further surgery it would need to be somehow "medically necessary" - have you got medically documented problems with them? The insurance was required to pay for the reconstruction. I don't know that it is required to pay again to deconstruct if not for something like infections, etc.

ashell

When I told my PCP about my desire to deconstruct, she made a note that the implants are causing me pain and mentioned that that is necessary for insurance to cover it. The implants do cause me pain, though not constant. They are constantly uncomfortable. I'm not sure if that is enough for insurance to cover it. Sigh.

Aussie-Cat

ashell, I suspect that insurance is meant to cover it but it helps your case that the implants are causing you pain. If your PCP said your insurance should cover it, why do you doubt that? My suggestion would be to try not to keep putting it off for too long. Maybe it won't take as long to recover from as the other surgeries you've had.

ashell

@aussie-cat - thank you. I am suddenly doubting it because of the continued push back. Pushing it back makes it seem like it's not important to me, when it is, I just don't want to disrupt my life. I emailed my plastic surgeon, kind of rambly, saying maybe I should come in for another appointment and to discuss the surgery and recovery time. Sigh. I'm prone to anxiety and suddenly made myself really anxious about this.

Lagom

Think of it this way, someone could have awful knee pain and be in dire need of a knee replacement, but need to reschedule it due to various scheduling conflicts, family commitments, etc. That doesn't make it any less medically necessary. Same goes for your surgery, just because it's not urgent / emergency doesn't mean it won't qualify as medically necessary.

ashell

Thank you! Good point.

I actually explanted 2 weeks ago for the hefty price of $10

So happy with my decision to go flat

ksusan

I'm glad it worked out!

Jujibean

ashell, my surgeon told me insurance companies pay for all surgeries for bc. So he told me if i want an explant, or a correction, or a reduction, it doesn't matter when you do it. It is all covered. It is not cosmetic surgery. I don't know if that is because i live in california. But ultimately you have to ask the insurance company to be sure. Good luck.