Fw: WASH POST: Breast Implants / Insurance A Complicated Issue

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

From: " ilena rose " <ilena2000@...>

<ilena@...>

Sent: Tuesday, January 20, 2004 3:25 PM

Subject: WASH POST: Breast Implants / Insurance A Complicated Issue

>

>

> http://www.washingtonpost.com/wp-dyn/articles/A26262-2004Jan17.html

>

> A Complicated Issue

> A Weekly Check on Health Care Costs and Coverage

> Tuesday, January 20, 2004; Page HE02

>

>

> Amy Kephart's routine mammogram last year proved to be anything but

> routine. The image for her left breast led her doctor to recommend a

> needle biopsy. The biopsy, Kephart said, led to an infection. The

> infection required surgery that kept her in Inova Fair Oaks Hospital

> for several days in September, costing her more than $1,000 and her

> insurance plan thousands more.

>

>

>

> Case closed? No. In December, her insurer, the Health and Welfare Fund

> of the United Food and Commercial Workers Union, asked the various

> providers for its money back, saying Kephart's claims had been paid in

> error. " It has come to our attention, " the fund wrote, that Kephart's

> treatment " was due to complications from previous breast implants

> approximately 10 years ago, " and under Kephart's policy,

> " Complications resulting from cosmetic surgery are not covered. "

>

> Kephart, who lives in McLean and works for Safeway, is appealing the

> denial, and she has hired an attorney to try to ensure that she won't

> be stuck with the bills. Regardless of how her case turns out, it

> illustrates some of the problems facing women who have breast

> implants, either after mastectomy or to enhance their physique.

>

> " This implant needs to be removed in order to allow for resolution of

> the . . . infection, " plastic surgeon G. Goldberg wrote in a

> memo before operating on Kephart. In a follow-up, Goldberg reported

> that he had found the implant to have been ruptured, " with free

> silicone within the left breast tissues. "

>

> " Usually things are kind of black or white, " Goldberg said, but

> sometimes deciding whether a breast problem is a complication of an

> implant " is absolutely a gray zone, " and " unfortunately the insurance

> companies are making the final determination. "

>

> Kephart said she was unaware of her policy's exclusion of

> cosmetic-surgery complications. If she had known that the biopsy and

> mammogram might confront her with expensive health problems, she said,

> she would have skipped them.

>

> " You certainly don't want her not to have mammograms, " said

> Zuckerman, president of the National Center for Policy Research for

> Women & Families, " because the mammogram could help you find out if

> you have breast cancer. "

>

> Zuckerman said she did not know of others avoiding tests for financial

> reasons, but " I hear more from women who don't want to get mammograms

> because they're afraid their implants will break " during the exam.

>

> " I've spoken to so many women who say this has happened to them, " said

> Zuckerman, whose group promotes research on the safety of implants.

> " It certainly seems likely that a mammogram can break a breast

> implant. "

>

> Indeed, the Food and Drug Administration urges women to alert

> mammogram technicians to " use special techniques . . . to avoid

> rupturing the implant. "

>

> -- Tom Graham

>

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