I KNEW something would come along to make me stress before the exchange. I KNEW IT! Things cannot go simple for me. You see the counter ----> FIVE DAYS. I am so ready. That's all I can think about when I lay down to go to sleep at night, as I toss and turn trying to find my "sweet spot" that doesn't feel like I'm laying on top of a boulder. Then I think about it again when I wake up in the morning and my hand instantly goes to my chest, afraid I've damaged the expander some how in my sleep.
I'm tired of being the mastectomy girl. Well, I take that back. I'm tired of worrying constantly about infection, about leaking expanders, about whether or not insurance is going to pay for my surgery, about contracting an infection in surgery that leads to my implant having to be removed. I'M DONE!
Which leads me to the bump in the road, the snafu in my plans. I knew my doctor's office had yet to hear from either insurance company. I figured it was no big deal and that there was NO way they could deny the claim.
Wrong.
My primary insurance...who ironically I wasn't covered under when I had my PBM is covering the surgery no problem. I just have to pay my deductible ($1200) and 20% coinsurance ($235.28). My secondary insurance, which I was really looking forward to (has a $150 deductible and 10% co insurance) has apparently decided that Cowden's falls under a "congenital defect" and thus falls under their exclusions.
Umm..what?
When my PS office told me this, I immediately said, "They paid for my mastectomy!" I was told they did because of how it was coded and they could very well come back and ask for their money back. Well, I'm fairly certain that is illegal, but whatever.
In my previous dealings with the billing department in my PS office, they've been....less than helpful. Not going to go above and beyond. The first "no" she hears, and that's the end of it for her. I, on the other hand, have just begun to fight. My first plan of action is to call the insurance company tomorrow and see what's going on. If I find out it's something stupid that the billing department should've taken care of...well they'll see a side of me they haven't seen.
We'll see. Time for the gloves to come off. I've got plenty of resources and the law IS on my side:
http://www.dol.gov/ebsa/publications/whcra.html
http://www.genome.gov/24519851
All I know is I'm getting my implants on Tuesday. WOO WOO WOO! (You know it ;) )
Wow! I'm sorry you're having to deal with insurance difficulties on top of everything else! Sounds like there has to be a mistake or misunderstanding somewhere along the line on their end! That is crazy that they would deny coverage for reconstruction after paying for mastectomy! No way! Id like to hear how it all goes down once you talk to them. I'm assuming it will end in a big apology!
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