Re: Shari & others who had insurance pay for explant

[Guest guest]

Billie Jo,

My insurance paid for my explant because of my capsular contraction not my illness. My Dr. wrote a letter to Blue Cross. By any chance do you have cc?

Barbara

[Guest guest]

Pam/others

I had United Healthcare who also had the same exclusions. When I called them to ask, they stated that if I could prove that they were leaking or had capsular contracture then it would be a medical issue which would be covered. I self paid as I didn't want to wait to get the MRI to prove that they were leaking then wait the weeks for the appeal-I wanted them out right then!!! I found a local doc that was very understanding (my original PS who did the first operation as well as the other two ops to fix complications wouldn't do it - he said I would regret it so maybe I ashould wait six months and see - he was a real ass) This doc also knew I was self pay and gave me a pretty good price. upon explantation (I guess you may have seen the yucky implant pics I posted last week) Doc Bridge - my new PS - stated that one had mold growing into the valve holding it partially open and it weighed in at 30 cc's under the 250 that I originally had implanted so it was obvious that they were leaking. the other was 15 cc's off. I also immediately sent them to Doc Blais in Canada who confirmed that both valves were faulty/leaking and contaminated w/ at least 12 namable organisms. Doc Bridge wrote my insurance a letter stating that upon explantation the implant weight discrepancies as well as the moldy/tissue ingrown valve.He also stated in the letter that the mold he saw in the valve could definately have been the cause of my symptomatic illnesses (he was so great!) I sent his letter along with doc Blais' report up to the insurance co. It took about 4 months but I got my money back less my co-pay. Trust me guys - with all I have read and from talking w/ doc Blais, all the salines leak. Mine were Mentor 1996 and 1999. Ultrasound can measure the fluid and look at the valve to see if they are leaking - if the fluid is less than your original operative report states then you have a case. In my case I did not want to wait another day - my total explant was $1900.00 including the hospital fees, etc. (I did not get a lift) more than likely you guys have capsular contracture to some degree also as our bodies were always fighting w/ scar tissue. don't massage anymore - not even a little. lay off the vitamin E and the scar tissus will build up in no time at all. this should be enough to get your insurance to pay. If you have to self pay and can not find a way to see doc Feng then come to Tampa - doc bridge was very nice and much less expensive although he has no where near the experience of removals as Doc Feng but if you have to do what you can afford.

I hope this helps!

Shari

[Guest guest]

That was my case as well. My doctor sent my insurance company a letter that stated I had Baker IV contractures. This describes the degree of capsular contracture, and insurance companies will most likely pay for explant for grade IV due to the liability issues that may arise if breast cancer is not caught because of obscurity from this scar tissue. I don't know for sure what I had--it sounded more like Baker III to me, but he said Baker IV, and that is what got my insurance to pay for it, thank God.

Here is some important info on the Baker grading system:

http://www.justbreastimplants.com/risks/capsule-contracture.htm

Baker Grading System - 4 Grades of Capsule Contracture

Baker Grade I - The breast is normally soft, and looks natural. (Basically, we all have this, since we all have a "capsule".) It is only when the capsule starts shrinking/contracting that capsule contracture occurs.

Baker Grade II - The breast is a little firm, but appears natural.

Baker Grade III - The breast is firm, and is beginning to appear distorted in shape.

Baker Grade IV - The breast is hard, and has become quite distorted in shape. Pain/discomfort may be associated with this level of capsule contracture.

Patty

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

From: BARBY4271@...

Sent: Sunday, February 15, 2004 8:05 AM

Subject: Re: Shari & others who had insurance pay for explant

Billie Jo,My insurance paid for my explant because of my capsular contraction not my illness. My Dr. wrote a letter to Blue Cross. By any chance do you have cc? Barbara

[Guest guest]

Shari,

I would like to know a little more about what you paid up front and who your Dr. is

I would consider taking the trip there if it would be worth it.

Hugs, Billie-Jo

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

From: halvey70@...

Sent: Sunday, February 15, 2004 5:19 PM

Subject: Re: Shari & others who had insurance pay for explant

Pam/othersI had United Healthcare who also had the same exclusions. When I called them to ask, they stated that if I could prove that they were leaking or had capsular contracture then it would be a medical issue which would be covered. I self paid as I didn't want to wait to get the MRI to prove that they were leaking then wait the weeks for the appeal-I wanted them out right then!!! I found a local doc that was very understanding (my original PS who did the first operation as well as the other two ops to fix complications wouldn't do it - he said I would regret it so maybe I ashould wait six months and see - he was a real ass) This doc also knew I was self pay and gave me a pretty good price. upon explantation (I guess you may have seen the yucky implant pics I posted last week) Doc Bridge - my new PS - stated that one had mold growing into the valve holding it partially open and it weighed in at 30 cc's under the 250 that I originally had implanted so it was obvious that they were leaking. the other was 15 cc's off. I also immediately sent them to Doc Blais in Canada who confirmed that both valves were faulty/leaking and contaminated w/ at least 12 namable organisms. Doc Bridge wrote my insurance a letter stating that upon explantation the implant weight discrepancies as well as the moldy/tissue ingrown valve.He also stated in the letter that the mold he saw in the valve could definately have been the cause of my symptomatic illnesses (he was so great!) I sent his letter along with doc Blais' report up to the insurance co. It took about 4 months but I got my money back less my co-pay. Trust me guys - with all I have read and from talking w/ doc Blais, all the salines leak. Mine were Mentor 1996 and 1999. Ultrasound can measure the fluid and look at the valve to see if they are leaking - if the fluid is less than your original operative report states then you have a case. In my case I did not want to wait another day - my total explant was $1900.00 including the hospital fees, etc. (I did not get a lift) more than likely you guys have capsular contracture to some degree also as our bodies were always fighting w/ scar tissue. don't massage anymore - not even a little. lay off the vitamin E and the scar tissus will build up in no time at all. this should be enough to get your insurance to pay. If you have to self pay and can not find a way to see doc Feng then come to Tampa - doc bridge was very nice and much less expensive although he has no where near the experience of removals as Doc Feng but if you have to do what you can afford. I hope this helps!Shari

[Guest guest]

billie jo

I had to pay the enitre $1900 up front - about half to the doc and the other half to the hospital. My doctro was Dr. Bridge - Bride breast and asthetic center. He and his wife have a practice and their main surgeries are reductions and breast cancer. His info is posted in the files section under recommended doctors - let me know if you can't find it and I will look it up for you. His office is in - a suburb off of Tampa. It is about - minutes from Tampa Intl airport. hope this helps

shari

[Guest guest]

Shari, I'm going to give it a shot! Thanks for the info!

Pam

> Pam/others

>

> I had United Healthcare who also had the same exclusions. When I

called them

> to ask, they stated that if I could prove that they were leaking or

had

> capsular contracture then it would be a medical issue which would

be covered. I

> self paid as I didn't want to wait to get the MRI to prove that

they were

> leaking then wait the weeks for the appeal-I wanted them out right

then!!! I found

> a local doc that was very understanding (my original PS who did the

first

> operation as well as the other two ops to fix complications

wouldn't do it - he

> said I would regret it so maybe I ashould wait six months and see -

he was a

> real ass) This doc also knew I was self pay and gave me a pretty

good price.

> upon explantation (I guess you may have seen the yucky implant pics

I posted

> last week) Doc Bridge - my new PS - stated that one had mold

growing into the

> valve holding it partially open and it weighed in at 30 cc's under

the 250 that I

> originally had implanted so it was obvious that they were leaking.

the other

> was 15 cc's off. I also immediately sent them to Doc Blais in

Canada who

> confirmed that both valves were faulty/leaking and contaminated w/

at least 12

> namable organisms. Doc Bridge wrote my insurance a letter stating

that upon

> explantation the implant weight discrepancies as well as the

moldy/tissue

> ingrown valve.He also stated in the letter that the mold he saw in

the valve could

> definately have been the cause of my symptomatic illnesses (he was

so great!)

> I sent his letter along with doc Blais' report up to the insurance

co. It

> took about 4 months but I got my money back less my co-pay. Trust

me guys -

> with all I have read and from talking w/ doc Blais, all the salines

leak. Mine

> were Mentor 1996 and 1999. Ultrasound can measure the fluid and

look at the

> valve to see if they are leaking - if the fluid is less than your

original

> operative report states then you have a case. In my case I did not

want to wait

> another day - my total explant was $1900.00 including the hospital

fees, etc. (I

> did not get a lift) more than likely you guys have capsular

contracture to

> some degree also as our bodies were always fighting w/ scar

tissue. don't

> massage anymore - not even a little. lay off the vitamin E and the

scar tissus

> will build up in no time at all. this should be enough to get your

insurance to

> pay. If you have to self pay and can not find a way to see doc

Feng then come

> to Tampa - doc bridge was very nice and much less expensive

although he has

> no where near the experience of removals as Doc Feng but if you

have to do what

> you can afford.

> I hope this helps!

> Shari