Insurance and reconstruction..how long

[Sherryg683]

This might sound like a stupid issue considering all that we've gone through. But how long will insurance pay for breast cosmetic surgery after initial surgery. I had a lumpectomy in my right breast and all and all it looks fine, scars are very small. It's just now about 2 sizes smaller than my left breast. Most people wouldn't even notice it and it's not that huge of a difference, but it does effect my bra and it bothers me. When I look down at myself I just see this big left boob and a smaller right one. I would really like to have the left one reduced because I've never been a fan of big breasts. Would insurance even consider paying for something like this. I know a lot of people are slightly lopsided naturally but I wasn't. I'm not overly vain, I'd just like my boobs to match like before.. sherryg

[Chelee]

Sherri, I am pretty sure that there was a law passed back in 97 or 98 that says insurance companies have to pay for reconstruction. I don't believe there is any time limit on that either. (I suppose there could be difference's in some states...but I doubt it.) I really do believe they have to cover you. Someone correct me if I'm wrong.

Chelee

[hutchibk]

I was advised early on that they have to pay for it until it is right...until you are happy with it. And if that means several surgeries to get to that point, then they must pay. You must make sure that the cosmetic surgeon codes it correctly, too.

After my initial recon, my first implant was not the correct size, it was just a bit too small. We went in a year later to remove scar tissue and at the same time replaced the implant with the proper size. My insurance was responsible for the correction of size, as required by law.

[Sherryg683]

Since I don't have any implants (a lumpectomy was done). I just was wondering if they would think it was foolish to worry about making the other breast match the one that was operated on, since it's not a huge difference. When I was first diagnosed I figured "what the hell", I probably won't be alive long enough to care. But now I am reconsidering this and would like to have breasts that are symetrical. I have a good plastic surgeon, so I think I will contact him and see what he thinks..sherryg

[Mary Jo]

For what it's worth, I was told by my insurance company that I have 5 years to decide if I want reconstruction and they have to pay for it. I'm not quite sure what would happen if I opted for reconstruction in year 6 or 7 but that's what they told me. I am not having reconstruction so it isn't something I've ever researched but just sharing what I was told.

Mary Jo

[new shoes]

www.plasticsurgery.org/patients_consumers/links_resources (http://www.plasticsurgery.org/patients_consumers/links_resources)

This explains the law in "non-legaleze". The federal law only relates to reconstruction after mastectomy. And the health insurance must cover any reconstuction or modifications for as long as you are a policy holder, for any reason (so if I decided I want "Dolly Partons" next year my insurance must pay for it). Things change when you switch to Medicare.

Unfortunatley I don't think the law covers lumpectomies. I have a dear friend of 15 years who was diagnosed at the same time I was. As she was ER+/PR-, Her2-, she opted for a lumpectomy. She is trying to get her insurance to cover modification of the lumpectomy sight and reduction of the other breast (she is a DDD cup). So far they have denied her.

I hope this helps clear things up.

[jener8er]

This is interesting to me as I am STILL fighting my insurance to cover revisions to my reconstruction I started last year. They are saying it is cosmetic and not covered. Anyone know HOW to enforce this law on your insurers? I've appealed and appealed and they've now approved revisions to my left breast but not my right - even thought they covered a right proph mastectomy last year. VERY frustrating, especially when I hear things like this about they have to cover it until you're satisfied. I would check with them thoroughly before you do anything. Good luck! Anyone else got any suggestions?
Jen

[Patb]

Sherry
I have the exact same problem. I had a lumpectomy also and they
do not match at all now. My surgeon said any surgery will be covered
but I can't make up my mind. It has been 15 months.
patb

[Mgarr]

Sherry,

My mother in law had this problem and she had reduction of the other breast all covered by her insurance because it was considered "reconstructive from breast cancer surgery. I can also tell you she has been very happy with the decision.

Good luck.

Mar

[Sherryg683]

I have an appointment with my plastic surgeon for next week. His nurse said that she believed that insurance would only pay for corrections on the breast that had the lumpectomy and not reduction of the other. But also said that if they had to do any work at all on the effected breast that they then could reduce the other one and it be covered. She was not positive about this. I have great insurance who has never denied me anything, so we will see. I definately do not want an implant, just a little litle liposuction to the other one. Maybe they might have to do some scar revision or something to make the insurance thing work. ...sherryg