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 Andrew 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 Diana
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."

I had a HUGE lump in my breast that no one could feel......not the surgeon, not the radiologist, or my PCP. The only thing that detected my lump was a mammogram.
I realize that this is an imperfect test one at 40 some even question if I should have had....but it found my lump.
I do realize there are tons of people who mammography has failed them but fact is that the death rate from breast cancer is down due to more screening mammograms.Ultrasounds do not pick up microcalcifications. And yes I did have an ultrasound that confirmed the lump. Alex

From my experience and from what I heard from so many other woman, the mammograms were useless in detecting our bc. It was the ultrasound that ultimately found the lump. However, by the time I was sent for the ultrasound, the doctor had felt it and knew where to tell them to check.

I guess our insurance plans would never accept ultrasounds as a first option because they cost more but I think they need to give us a better option than those painful "squashum up" mammos. I cannot imagine anyone with an implant allowing them to do a mammo on their breast due to the process.

A study out of Japan shows that breast ultrasound is better at detecting cancer in women with implants than mammograms and no one in the medical field should be sticking needles in a breast with an implant in it.