Hack jobs

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jajjaaj
jajjaaj Member Posts: 60
edited March 2018 in Breast Reconstruction

It has been 3 years since my double mastectomy, and I have decided I don't want to look like a little old man with a paunch belly. No breasts literally makes me feel and look this way. Since my insurance does not cover any out of state treatment, I've been looking for a doctor in state, but feeling a little frustrated. After reviewing the gallery of all those that do accept my insurance, I've decided I don't want to choose any of them. All their best work looks like major hack work. I don't know what to do. I don't have much longer before my insurance won't cover any surgery, and I feel like I'm stuck with this mess forever. I just can't afford paying cash. I also have serious damage from the radiation that will require a skin graft, which increases the cost. I feel like I need to stand on a street corner in the right neighborhood and beg for reconstruction surgery from a decent surgeon. There has got to be a better way.

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  • Lula73
    Lula73 Member Posts: 1,824
    edited August 2017

    what state are you in? And what insurance do you have

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  • jajjaaj
    jajjaaj Member Posts: 60
    edited August 2017

    I'm in Colorado. My provider use to be a PPO, but through a series of changes in policy, that's no longer true. More like an EPO. If I go to someone not on their approved list, they won't pay, unless it's an emergency. 

    Fact is, I have a choice... live with the mess I have now, or end up with a bigger mess using their 'approved' doctors. I could change insurance companies, but face an even higher cost in premiums and deductibles due to my 'cancer'. This was the cheapest I could find.

    With all the steroids, I gained a lot of weight. Getting back to normal, but the belly won't go away. Just makes me feel like a little old man with a beer belly. I might as well stuff a bra, and sport a new figure with a tummy tuck. Over all far cheaper.


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  • Lula73
    Lula73 Member Posts: 1,824
    edited August 2017

    are there any in network Microsurgeons in your area that do DIEP flaps? If not, you should be able to go out of network and qualify for out of area coverage (means higher reimbursement than standard out of network coverage. Also have you checked to see if any of the docs in NOLA at the center for restorative breast surgery or in Charleston (Dr Massey or Dr Craigie) are on the approved list

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  • Lisey
    Lisey Member Posts: 1,053
    edited August 2017

    Jai, If you belong to Kaiser CO (not sure based on your description).. I can tell you an amazing PS who can do almost anything. PM me if you have Kaiser.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited August 2017

    My name is Audrey and I am the physician assistant with Dr. James Craigie in Charleston, SC. We help patients all the time from many states away who have had failed reconstruction, have postponed reconstruction or want something more natural. We work with nearly all insurances and have great plans in place especially to help women who want to travel all the way to see us. I would be happy to answer your questions or give you more information here on this forum or we could schedule a telephone consult. Please let me know if I can help

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  • jajjaaj
    jajjaaj Member Posts: 60
    edited October 2017

    Not sure what your response was, it was removed? 

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  • jajjaaj
    jajjaaj Member Posts: 60
    edited October 2017

    Lisey, I don't have Kaiser.

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  • jajjaaj
    jajjaaj Member Posts: 60
    edited October 2017

    Just to reiterate, my insurance is fine, but they will only pay up to 5 years after the mastectomy.  My time is getting short. I've researched the surgeons that will take my insurance, but the work they posted looks terrible, and I'm not talking about scars, etc. I'm talking about total hack jobs on these women. How does a plastic surgeon stay in business like this? I'm not that desparate.  

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  • SummerAngel
    SummerAngel Member Posts: 1,006
    edited October 2017

    What kind of recon are you thinking about? My PS was great but I don't know if he does delayed recon.

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  • jajjaaj
    jajjaaj Member Posts: 60
    edited November 2017

    SummerAngel, I'm not really sure what my options are. I know I have damage from the radiation, but not sure what would need to be done to fix it, or what choices I have for reconstruction. I am seriously in the dark. 

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  • SummerAngel
    SummerAngel Member Posts: 1,006
    edited November 2017

    I think your best bet would be to go talk to a few plastic surgeons and get an idea of your options. If you have a lot of damage and are concerned about that you might want to go as far as getting an opinion from the top doctors in New Orleans. I don't know if they will do remote consultations but if you want the opinion of the best, these doctors fit the bill.

    For local people, when I was looking there were only a couple of places that would do DIEP flap, if that's of interest to you. One is the University of Colorado at Aurora (UC Health), and another is Park Meadows Cosmetic Surgery. The guys at Park Meadows have a cap on their cost, even if insurance won't cover it. My surgeon is in Boulder, Dr. Hartley at Boulder Plastic Surgery. Even if he can't do the surgery because of the delay or damage or the type you want (he only does implant) he's a great doctor and will give you an honest opinion.

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  • Trvler
    Trvler Member Posts: 3,159
    edited November 2017

    Please, PLEASE check with NOLA before you do any DIEP. You never know. If you can show that there is no one in your network to do it, they will sometimes give in network rates. Even the best PS's in Chicago botched people. When I was at NOLA, I met a woman who had gone to the doctor I almost went to, who had a very good reputation here. She got a horrible infection and had to treat herself because she was a doctor. Something about him not wanting to report that she had an infection she he wouldn't treat her.

    When I was doing my research, I had a consult scheduled with this guy. The wonderful ladies in the NOLA group on here told me to ask his conversion rate. I didn't even know that that meant. I asked and they said 85%. I found out that means what percentage of the time they intend to take only fat but are required to take muscle in the operating room to get a blood supply. Further research told me the rate you want is ZERO because taking muscle can cause lifelong debilitating pain. The reason NOLA's rate is zero is because they do a CT scan before you even go in the OR. This Chicago doc doesn't do that. This is NOT the surgery you want to just let anyone do. You are smart to be concerned. Message me if you want to talk more about your options.

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  • Lula73
    Lula73 Member Posts: 1,824
    edited November 2017

    how about this? Give NOLA a call and schedule a consult with Liz the nurse educator. Then if you like what you hear let Vickie run your insurance verification and get back with you on what your portion would be. Sometimes Vickie's department works miracles when it comes to insurance regardless of what you read in your coverage packet. Whatever amount she gives you is what you will owe period, regardless of what is billed to insurance and subsequently paid by insurance. There is no cost to do the consult or the insurance verification at all. And they do offer interest free payment plans too. You and your happiness with your body is surely worth at least a little free investigation.

    Dr Dellacroce at NOLA did mine and I can't be happier. Here's a YouTube link to a talk he did in Norwich in front of hundreds of other microsurgeons on flap recon. I post this one because of the case study he ultimately presents of a woman whose recon (done elsewhere) was a total hack job plus she was thin. The end result is nothing short of amazing especially considering what was left for him to work with.

    https://m.youtube.com/watch?v=lGmoI21Tfbc


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  • Outdoorsy
    Outdoorsy Member Posts: 35
    edited December 2017

    Lula73, As I was searching through posts, I ran across your reply and wanted to say, "Thank you!" The video link you shared is very informative! I left a voice mail with Vickie at NOLA regarding my insurance to see if they would be willing to work with my insurance (since they are out of network).

    Jajjaaj, I hope you were able to find a surgeon that you're happy with. Let us know how you're doing when you can.

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  • Trvler
    Trvler Member Posts: 3,159
    edited December 2017

    They WILL work with out of network providers but just KNOW that you CAN negotiate. Don't be too timid to do it.

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  • Outdoorsy
    Outdoorsy Member Posts: 35
    edited December 2017

    Thank you, Trvler.

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  • jajjaaj
    jajjaaj Member Posts: 60
    edited March 2018

    Outdoorsy, haven't found one yet, but really getting diligent now. I really thought I could just live without, but I really can't. Nothing fits right, and I just need some boobs!

    Trvler, I didn't know we could do that? I'm definitely going to try. Thanks.

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