Has anyone had BC/BS Insurance pay for explant?

[Guest guest]

Pam,

I had my explant 9/24/03 and my insurance covered the procedure. I have healtmate coast to coast. My Plastic Surgeon wrote a letter to my insurance company because I had a grade 4 capsular contraction on my right breast and they approved it due to the capsular contraction. They approved the explant and bilateral capsulectomy and all hospital fees,etc. He only wrote about the capsular contraction not my systematic illness. Do you have capsular contraction? Also, what area do you live in?

Barbara

[Guest guest]

I heard from one of the members () that her insurance (which is

BC/BS) paid for her explant. Has anyone else been able to get their

insurance to pay? I would appreciate knowing how you documented

your " case " so that they would pay. I've been out on disability

since May and my condition is considered pre-existing so I have no

income. I have a credit card with about 8K left on it and my surgery

could cost 10K or more. I'm sure I won't be able to get a loan

because I don't have a job. I need as much information as possible.

Thank you so much. You all are truly the best thing since sliced

bread! I am so glad that I found this site - especially to find out

that I'm not crazy and that it's not all in my head and the most

important thing is that there is hope for me, that I will get better

after getting the poison out! Thank you again! Pam

[Guest guest]

My explanting surgeon got my insurance to pay, and from what I understand it was due to his letter stating I had Baker IV contractures. He did not state that I had saline implants, or how long I had had them. (which at that time was only 8 months!) I am quite certain that the Baker IV contractures are what got it approved, because it is known that contractures interfere with proper breast imaging, and are considered a liability for the insurance company if breast cancer goes undetected (the cost of more advanced cancers getting astronomical...)

This is just my take on it, and if anyone else knows more about the whole subject, comments are welcome...insurance is not my forte.

Pam, I hope this helps you. I am sure there are answers for you--almost every woman goes through this hurdle when faced with the prospect of explant, but somehow it all works out. We'll help you as much as we can!

Patty

----- Original Message -----

From: nannapam37

Sent: Tuesday, November 11, 2003 8:14 AM

Subject: Has anyone had BC/BS Insurance pay for explant?

I heard from one of the members () that her insurance (which is BC/BS) paid for her explant. Has anyone else been able to get their insurance to pay? I would appreciate knowing how you documented your "case" so that they would pay. I've been out on disability since May and my condition is considered pre-existing so I have no income. I have a credit card with about 8K left on it and my surgery could cost 10K or more. I'm sure I won't be able to get a loan because I don't have a job. I need as much information as possible. Thank you so much. You all are truly the best thing since sliced bread! I am so glad that I found this site - especially to find out that I'm not crazy and that it's not all in my head and the most important thing is that there is hope for me, that I will get better after getting the poison out! Thank you again! Pam

[Guest guest]

The way most women have gotten insurance to pay for their explant is, with the help of their doctors, convince the insurance company that it will cost them more in the long run to keep the implants in that to take them out. It takes a strongly written letter from their doctor, along with a history of illness/disability, or evidence of a rupture to satisfy them.

I don't remember specifics, but I do think the BC/BS has paid for removal.

If they balk, they should be reminded that insurance pays for the consequences of smoking and drinking, plus a multitude of illnesses related to behavior that lead up to illness.

Rogene

Rogene

nannapam37 <Nannapam37@...> wrote:

I heard from one of the members () that her insurance (which is BC/BS) paid for her explant. Has anyone else been able to get their insurance to pay? I would appreciate knowing how you documented your "case" so that they would pay. I've been out on disability since May and my condition is considered pre-existing so I have no income. I have a credit card with about 8K left on it and my surgery could cost 10K or more. I'm sure I won't be able to get a loan because I don't have a job. I need as much information as possible. Thank you so much. You all are truly the best thing since sliced bread! I am so glad that I found this site - especially to find out that I'm not crazy and that it's not all in my head and the most important thing is that there is hope for me, that I will get

better after getting the poison out! Thank you again! Pam