As some of you know I'm trying to get my HMO to approve a pro mast. I've been denied twice after letters were submitted to them from 2 of my doctors. I'm not done yet, I still have the rights to appeals, but would love to go in with some ammo so to speak...This is where I could use the help. I saw my PS in Sept. and he was very honest with Gene and I about the proceedures he could do. He told me based on what I've already had done {mrm/immediate recon lat flap with saline implant} that I'd not have "symmetry from day one" if I had "mastoplexy" surgery which is the second option he gave me after mast and just saline implant. {he'll will do either one}...but mastoplexy more then likely would require other surgeries if I wanted to retain symmetry long term because it would age with me. {loose weight gain weight etc} Obviously, if I'm going to have this surgery, then it would be nice if I didn't have to have multiple ones to keep this appearance.
I've researched the WHCRA {women's health and cancer rights act of 1998}
There's a section that speaks about recon if a women opts for recon after mastectomy. It says that if the insurance carrier covers mast and the women opts for recon afterwards they're responsible for paying for this. It goes onto say they're also are obligated by this law to pay for surgery/recon on the other breast to get "symmetry"
Okay....what I need to know is what _exactly_ {or close} do they mean when they say "symmetry" The clause quoted is all it says...And I can't find anywhere that breaks it down, and spells out what our right really are regarding this type of situation.
The clause I'm questioning reads:
"Surgery and reconstruction of the other breast to produce a symmetrical appearance"
The article that I read was found on "IVilliage" but I have found other sites that carry basically the same information as this one, regarding the text of the law.
I will only quote the first paragraph of this article. And this is _only_ for the purpose to draw attention to a particular part of it that seems to imply this law/coverage seems somewhat unlimited as far as what they are talking about regarding "symmetry"
It says "During the final days of it's 1998 session, Congress passed a massive budget bill to appropriate funds to nearly every component of government. Included in this mammoth piece of legislation was the
Federal/mastectomy Women's Health and Cancer Rights Act of 1998 {WHCRA}, a pet project of former Senator Alfonse D'Amato {R-NY} The WHCRA, effective for health plan years begining on or after October 21, 1998, madates broad coverage for breast reconstruction and complications of mastectomy surgery"
The term "broad" implies that whatever it takes to achieve symmetry would be covered under this ruling/law.
Here is the url for IVillage, but not sure the page is still able to be accessed as I saw this/printed on 8-15-03.
http:www.ivillagehealth.com/print/0,,172313,00.html
I typed "breast reconstruction" from my homepage search area {msntv}to get this.
If you're able to acess the page that has the quoted paragraph that I included here, the clauses I'm referring to would be listed as a, b, and c. "b" is the one I'm asking about.
I also found articles on The American Cancer Society Website. This one that I qouted was the only one that made reference to "broad coverage"
Thanks to all that have read this and thanks in advance to anyone that can offer any help with this. I'd prefer to in guns loaded next time.
Take care there/God bless/Have a great weekend annie
Ultimately.....we know deeply that the other side of every fear is a freedom.
"Courage"...is *fear* that has said it's prayers.
