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Did Anyone Have To Pay Part Of Their Reconstruction Bill Due To Insurance Issues?

A MyBCTeam Member asked a question šŸ’­
Pittsburgh, PA

I had a bilateral mastectomy in December with reconstruction in June. I just received a bill in the mail from my insurance company denying part of my reconstruction due to experimental mesh my plastic surgeon used. My PS told me that if they didn't use this mesh, the chance of it slipping would be high due to my thin build and my thin tissue. I did not know it was experimental, I just thought it was my only option. Now the insurance company won't cover the full cost of the surgery even though I… read more

August 21, 2013 (edited)
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A MyBCTeam Member

@A MyBCTeam Member. I bet you have a HMO plan. Is this correct? If so, you have to stay on top of the situation before and ask a lot of questions. I learned the hard way. I signed up for a HMO plan medicare replacement and they work hard to deny you. It has been nerve racking for me to get the doctors I need and not who they want me to see. And I realized I needed to ask questions. a lot of questions. I agree with cyn who said appeal it. Often the reports are not sent in for proof to back up what you need. There are surgery reports that are kept separate than the patient health records. dig deep and ask the hospital for your surgery reports. FYI

August 29, 2013 (edited)
A MyBCTeam Member

You can appeal your insurance decision. Call one of the specialists and ask what the appeal process is. Typically it involves sending a letter explaining 1. that you did not understand this is was an experimental option and 2. The doctors office did not notify you that you would be responsible for that portion of the bill.

Definitely worth giving it a go. You can also notify the hospital that you are contesting the insurance company's decision so that they do not turn you over to collections.

August 22, 2013
A MyBCTeam Member

All I have to pay is my co-pays.

August 24, 2013
A MyBCTeam Member

I had alloderm used in feb. Still haven't seen a bill.

August 21, 2013
A MyBCTeam Member

Or strataderm. See I don't even know the name so how would I know it was experimental?

August 21, 2013

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