I’ve got an appointment with a plastic surgeon next week to have a chat about symmetry following a WLE last year.
I’m going to need work on both breasts to even things up.
I’ve contacted my insurance company and they’ve told me to get a procedure code as plastic surgeons often charge outside of their guideline prices and there may be a shortfall (which they said can often be a large sum)
I’m concerned now as I have no funds to pay towards it and am desperate to get it done.
Has anyone else come across this or am I jumping the gun and worrying unduly?
I suppose I could if push came to shove but I was always told (by my original surgeon) that my insurance company would pay for me to be ‘put back as I was pre-cancer’.
The other option would be to search for a plastic surgeon that operates within their guidelines and of course NHS waiting times are so long.
Hi Gingery, I had WLE, and SNB in June. My surgeon is an onco-plastic surgeon and she did everything at the same time. So I had a bilateral reduction as well. I think you should definitely look at not paying for this. I understood that this is standard practice.
I’m sorry to have to inform you…but I have experienced terrible problems with my Health Insurance Company trying to gain symmetry. In my case not only was there a shortfall in the surgeon’s fees for the initial reconstruction but they also have loads of restrictions on their policies the result being that they won’t cover the work I need doing to gain symmetry. Like you I thought they would cover to ‘pre-cancer state’ but this was actually not the case. Unfortunately for me they didn’t tell me of any restrictions on my policy until after the initial reconstruction! It turns out they would not pay for any revision to the reconstructed breast but they will pay for work on the unaffected breast. I don’t want my unaffected breast amending as changing the reconstructed breast is the easiest option, so I am having to self fund the ‘tweaking’ that is needed. I was told I could have it done on the NHS, but the wait was just too long and I’d already waited so long since the initial reconstruction and I just want everything finished.
I hope your insurance company are more generous than mine, but I would strongly recommend you find out any restrictions you may have on your policy, as well as any shortfalls. Then you can make an informed decision about proceeding.
Speak to your surgeon about it…they won’t know the limitations of your particular policy cover but if they tend to charge ‘higher than normal fees’ I’m sure they will have come across this before. They will also probably have to write to the insurance company before hand anyway to tell them what procedures are needed.
Quick update…I spoke to my insurance company again today to see if they had any plastic surgeons on their list that did charge within their guidelines, unfortunately they didn’t have any in my area but when looking at my policy they said I was fully covered and had no limits set and so could go ahead a book in as soon as I wanted.
I am looking for reconstruction after bilateral mastectomies in 1983 and 1986. Have been insured for over 36 years and have been told by insurance company that it is cosmetic surgery and they will not pay. I really disagree because cosmetic is enhancing something you already have and reconstruction is trying to reconstruct as close a possible that which has been taken by traumatic disease and mutilating surgery. The surgeons who I have spoken to think it awful the way the insurance companies treat us. Maybe we should do more to bring it to light especially as breast cancer awareness month is in October
Sophieanne
I agree and that is terrible, it certainly isn’t cosmetic. I was told when first diagnosed that my insurance company would pay to put me back as I was pre cancer, although I didn’t have an mx I’m sure the same must apply.
I wish you well in your battle to get them to cover the reconstruction.
Thanks for you concerns. I am insured with Standard Life. Today I have contacted This Morning at ITV asking them if they would like to feature our problems during October (breast cancer awareness month) I am also going to contact the Daily Express who has been giving its centre pages to women who have had cosmetic surgery to succeed in the workplace - Ann Robinson was featured. Will keep you informed
Sophieanne. P.S. We need to do all we can to publisize this as they are treating us as if we are having nose jobs.
Hi Sophieanne
I cannot understand how these insurance companies class reconstructions as cosmetic. They take our money quick enough, but when it comes to paying up they find an excuse to get out of it and this one is diabolical. I’m insured with BUPA and had to have an op to take out a ruptured implant and I chose to have a DIEP flap replacement to hopefully avoid more surgery over the years. BUPA would not meet all of the plastic surgeon’s fees and luckily for me my son paid the difference (about £3000). Now I need another op as I have a bulge on one side of my tummy and the DIEP needs to be reduced to match the normal one. Again BUPA will not meet all of the PS’s fees and I am having to pay about £700 (again my son has kindly agreed to pay). I’m sick of being treated as if I’m having a boob job!
Carole
Good for you, get out there and tell it how it is.
I don’t have much time for Ann Robinson I have to say. I wouldn’t want us to be seen as some kind of comparison unless they want to give us access to her bank account!
No, I think publicity is the way to go, in fact a plastic surgeon recommended it recently.