Mastectomy: A Bump in the Road

My mastectomy surgery is 14 days from today, and I had a great day today.  Really, I did.  I’m making sure I exercise by walking each day.  Today I walked faster than I have in the past several weeks and I walked further.  I spent almost an hour out walking!

Mastectomy ready
Out for a walk

curtainsMy mastectomy home: “new” curtains

I had lunch with some friends today and spent the afternoon looking for an affordable solution to my curtain issue.  My bedroom has a set of curtains that, because of the way we had to hang the curtain rod, cannot close over the whole set of windows.  They were hung for decoration vs. function.  Well, now that I’ll be sleeping in a chair right next to those windows, I wanted to make sure I’d have an easier time napping.  Curtains are expensive, though, people!  So, I had to get creative.  I went to Home Goods and ended up buying a set of panels for my daughter’s room for $25 so I could steal her curtains for my room!  The price of those curtains at Home Goods was the price for a single curtain panel at Target.  Anyway, the curtain situation is much improved in my room now.  Granted, it’s not that great aesthetically, but it will work for the time being.

Pretty successful day, right?  well, it was…

…until I opened the mail.  Let’s just say that my insurance company and I have a bit of a conflict.  They denied coverage of my reconstructive surgery.  I don’t get how this happens.  They approved my hysterectomy and oophorectomy.  They have in their code that “Aetna considers prophylactic mastectomy medically necessary for reduction of risk of breast cancer in any of the following categories of high-risk women”…[including] “Women who possess BRCA1 or BRCA2 mutations confirmed by molecular susceptibility testing.”  Therefore, I should also fit the following criteria that, “Aetna considers reconstructive breast surgery medically necessary after a medically necessary mastectomy.”

image by Blake Burkhart on Flickr

What I find annoying about this is not the fact that I won’t be covered because, clearly I will.  The annoying part is that I will have to use valuable time tomorrow on the phone.  I need to follow up with my plastic surgeon to make sure they resubmit for the correct billing because Aetna rejected a code they should have covered.   In addition, I’ll be calling the insurance company first thing in the morning to see what exactly they have qualms about.  I have limited healthy time left, people.  My two weeks remaining until this mastectomy is like gold to me.  I don’t want to waste it on the phone working out something that shouldn’t be an issue!  I should be doing all the things I love to do and not feeling guilty about any of it.  Working out insurance coverage was not on my to do list.

Prophylatic mastectomy and insurance

What can you take away from this?  Call your insurance company when you start looking into docs and procedures.  I did this, but I didn’t do one crucial step–ask for the codes the doctors need to use when filing for these procedures to guarantee they will be covered under your plan.  You must be an informed consumer.  These insurance Consumer Policy Bulletins aren’t easy to find.  You need to know what to look for.  And, the codes you need are all the way hidden at the bottom under all of the medical research  (at least they are in Aetna’s case).  I still haven’t gotten the coverage for my genetic testing worked out but we haven’t been billed again, either.  Someone dropped the ball on that one when I asked for the genetics people to resubmit and gave them the codes they should use.  I never heard back.  It’s been months.  If you need to do a search to help with your insurance process, turn to Google.  Use the name of your insurance company + Consumer Policy Bulletin + either “breast reconstructive surgery” or “Prophylactic mastectomy.”  I’m sure you’ll have something turn up.

Well, this has turned into a very long post; if you’ve read this far I’m delighted.  I am not going to let this little blip get me down.  I’ll make sure my surgeries happen by being the proactive person that I am!  And, I’ll remember that I had quite a good day so there’s no reason someone else’s stupid mistake should sour my mood any longer.  It’s time I remember my mantra to “see life half full.”