brava bra/fat injections/insurance acceptance

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jseda
jseda Member Posts: 142
edited May 2015 in Breast Reconstruction

Ladies:  Am seeking your help. Any of you having gone the route of wearing the brava bra with follow up autologous fat transfer, what have you experienced as far as acceptance/rejection by your insurance companies. I'm the first in a study at the U of Wash. and have noted that my insurance does not cover autologous fat transfer secondary to the board stating its not proven. I see this as an area that they are not current in. I'm hoping I'll get lots of responses from this site so that I can address the need and present the data to the insurance review board in hopes that they will think out of the box and give women another option in their choice of breast reconstruction. Our state law is that all insurance has to cover breast reconstruction secondary to cancer etc. Hope to hear from you!!!

Thanks much

J

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited September 2011

    I had fat graft transfer to supplement my implants. My insurance paid for it (regence). I've heard most insurance won't cover the BRAVA bra though. I'm surprised they aren't covering the fat grafting though?

    I am in WA too.
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  • jseda
    jseda Member Posts: 142
    edited September 2011

    Hi Susan:

    Thank you for your reply. I'm rather surprised as well. They view this as either as cosmetic or unproven. My PS states they've been doing fat transfer for at least 30 years for many other applications. I merely feel they are just taking a stand until challenged.You're correct in that they do not cover the brava bra yet. I purchased mine and am amazed at how it works. In 2 1/2 weeks, I've noticed a change in sensation of the skin on my post mastectomy/failed DIEP side.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited September 2011

    Is your PS "coding" the FG part properly to insurance? Has their office dealt with your insurance carrier before?

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  • jseda
    jseda Member Posts: 142
    edited September 2011

    I would assume so. I have GH NW options which is big in Wash. Have calls into them for tomorrow.

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  • jseda
    jseda Member Posts: 142
    edited September 2011

    I believe the catcher in the paperwork game is that the lipid injections are secondary to a staged procedure secondary to previous mastectomy and failed DIEP, therefore, acceptable. My word of advice to all of you out there in the delimna of having any portion of your reconstruction done is to make 100% sure the diagnosis and procedures are all inputed absolutely correct prior to your surgery, including, but not limited to, in or out of network, correct diagnosis and procedure codes as well as is a staged procedure or not. This information is crucial in the billing process.

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  • jseda
    jseda Member Posts: 142
    edited September 2011

    Currently using the Brava system. Just want you gals to know this is very doable. Just have to be disciplined and wear as directed. You get use to it after awhile. I had a failed DIEP/mastectomy on one side. Minimal discomfort and they actually tell you to stop if you have any discomfort as most of the time, its associated with placement of the dome which can be easily corrected.

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  • Lunakin
    Lunakin Member Posts: 120
    edited September 2011

    Jseda, if you're in a study, shouldn't everything be covered? Doesn't seem like you should have to pay to be in a study. After all, they do studies to see if something works, or works better than standard treatment. And sometimes that means the new treatment doesn't work.

    For example, studies on new drugs entail getting the new drug gratis. I was considering a study on an adjuvant treatment which would have allowed me to get the (expensive brand name) study drug free. But I didn't like the CT scans required and decided not to do the study.

    What does the PI (Principal Investigator) on the study at the U of W say?  And for any of us possibly interested, who is the contact for this study?

    Thanks and best of luck with this.

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  • jseda
    jseda Member Posts: 142
    edited September 2011

    Hi Lunakin:

    Good question!! I do believe this is only a study for the U of Wash to give the green light to the procedure. Its not Brava's study. The U doesn't have the budget to fund all these studies for each department. I don't mind. If it wasn't for the 10 women stepping forward to go ahead and try it, it most likely wouldn't make the grade at the U. Kind of like we have to prove that there is a need and yes it works. Shall see. In this economy and greatly decreased medical reimbursements as well as rising medical costs, I believe the day of free anything are gone. Drugs are different as they are funded by the deep pockets of the drug companies!!

    Later

    J

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  • Lunakin
    Lunakin Member Posts: 120
    edited September 2011

    J,

     Thanks for the reply. No, I wouldn't expect the U itself to fund the study, but one would think even in these times there'd be some funds for research on reconstruction for breast cancer patients, if a good grant writer worked on a proposal. I'm an RN and worked on a NIH-funded study (not in breast ca) in the past. So it sounds like a pilot study or similar so that with good outcomes the head of the reconstructive surgery dept OKs the procedure as part of the surgeons' repertoire, so to speak.

    Hope all goes well. And keep throwing more letters of medical necessity at your insurance co; they often change their tune after the 4th or 5th letter.  And as you pointed out, reconstruction is supposed to be covered in WA state.  Sigh....  Best to you. Keep us posted!

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  • jseda
    jseda Member Posts: 142
    edited September 2011

    There is probably monies out there for research but I think it boils down to time and just dealing with day to day duties. These docs don't have time nor the expertese in tackling more paperwork than what they are already dealing with. The head of the PS dept is my surgeon and the study is for the U of Wash's acceptance of the procedure. It took a year to finally get things rolling.

    I did get my procedure okayed after about the 3rd go round. I'm also a nurse and am married to a physician so totally understand the big picture; reality!! Besides, with the ever changing codes and beaucoup insurance cos with their own individual rules, things are beyond crazy. Thanks for your reply.

    J

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  • jseda
    jseda Member Posts: 142
    edited September 2011

    Ladies:

    Words of advice in regards to getting insurance acceptance on breast reconstruction surgeries two and three etc., Make sure your PS documents and codes that your surgeries are staged and related to your initial surgery.( Have your docs make sure to enter a note that there will be additional reconstruction surgeries to complete your case at the very beginning; kind of like laying out a plan of attack so to speak.)

    J

    J

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  • GointoCarolina
    GointoCarolina Member Posts: 753
    edited September 2011

    I was going to be in the current trial for the Brava.The way it was explained to me is this trial is to prove that the Brava is safe to use for breast reconstruction.It is currently only approved for augmentation in the US.I was told the cost of the Brava and any dome upgrades would be my responsibility.The doctor agreed to take whatever my insurance would pay for the actual fat grafting.I never found out about the hospital or other fees.This doctor was not in network for my insurance.

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  • jseda
    jseda Member Posts: 142
    edited September 2011

    Hi :

    Was this in NY? Sounds similar to ours in Washington state. Unfortunately, it does depend on our insurance coverage. Do you have out of network with your insurance?

    J

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  • jseda
    jseda Member Posts: 142
    edited October 2011

    Good news!!! My insurance provided an in network payment of my procedure. I had to appeal as this procedure was part of a staged procedure from the original mastectomy 2009 and was a part of that referral in that the surgeon documented that I would require at least 2 more surgeries to complete reconstruction. Make sure your docs put something to this effect in their notes so if you do have to go back to something in an appeal, its there. Good luck

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  • dancetrancer
    dancetrancer Member Posts: 4,039
    edited October 2011

    That is GREAT news!  Yay! 

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  • Lunakin
    Lunakin Member Posts: 120
    edited October 2011

    J,

    Let us know how the procedure(s) are going and how you are doing. I hope all is well.   Thanks for your advice on dealing with the insurance leeches. I took notes for when I talk with a PS!

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  • GointoCarolina
    GointoCarolina Member Posts: 753
    edited October 2011

    Hi,jseda,yes, NY and  HMO.I can apply for out of network coverage.But since I would be in a clinical trial,that muddies the water.Insurance does not have to pay for devices or procedures that are not approved.That is why most trials cover the costs for participants.Lunakin, when I was considering a clinical trial for chemo,I was told the trial would cover all my costs,nothing would be billed to insurance and I would pay nothing out of pocket.It does seem strange that in a clinical trial to prove the Brava that the participants would have to pay for it.

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  • jseda
    jseda Member Posts: 142
    edited October 2011

    Hi Pandazankar:

    I think the difference is that this is not an initial clinical trial, such as Brava'a application for FDA approval. This is for a university and there are merely gathering data on someone else's procedure, to decide whether or not to allow this procedure to be offered at their facility. Hope this makes sense!

    J

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  • zitallis
    zitallis Member Posts: 1
    edited May 2015

    http://www.brava.com/

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