Tonight’s post is short and photo free. It’s been a tough day for a variety of reasons.
My left shoulder, clavicle and sternal area is afire with discomfort today. The girls had parent & tot swimming lessons again this morning, and Olivia took out her unwillingness to participate on, what felt like, only my left noob and abdomen. Being that flailing limbs are innate to swimming, I can’t complain much that I took a few body shots. But the after effects are massive today.
I also had a lot of wrangling to do with the girls before Mike got home from work. They woke up feisty and just wanted to pull each other’s hair out, so there were many time outs and subsequent apologies issued this evening. My physical therapist told me that I’m probably having so much shoulder and clavicle pain because I’m over compensating for my limited strength and ROM on the left side by using my entire shoulder girdle to do movements that usually only involve my shoulder itself. Even after doing my prescribed stretches and a little self massage, I’m throbbing and my swelling is really uncomfortable.
Today I scheduled my nipple reconstruction for June 22. When speaking with my reconstructive surgeon’s scheduling assistant, she wanted to bring my attention to the fact that not all of this procedure will be covered by my insurance. That conversation led me to make about 12 other phone calls today between my insurance company and the hospital, wherein I found out that my insurance is (currently) not paying the claims submitted for my DIEP flap breast reconstruction. There is an appeals process that we have to navigate our way through, but if my insurance denies payment we possibly have a long battle ahead of us. I have thought and talked so much about this today that I’m just exhausted on the various issues and potential avenues that all of this could go through. So, now I am even less interested in having my nipple reconstruction than I was before. Mike has encouraged me to forge ahead. I think that his position is subject to change once all of the related bills gets here.
For now, I’m hoping just to get to bed and not dream about selling my kidneys on the black market to pay for all of this.
P.S. Check out the “baby bundt cakes” and “skin sombreros” here.
shutupaboutit 
The insurance company ugh! A stress you should not have to worry about. I thought by law if they covered the mastectomy they had to pay for the reconstruction of your choice as part of the Women’s Health and Cancer Rights Act of 1998. http://www.dol.gov/ebsa/publications/whcra.html good luck and hope it works out quickly!
We have done a lot of reading about this in the past 24 hours. You would think that it was that easy. Unfortunately, each state law can come into play when disputing payment for the TYPE of reconstruction I elected to have. My sister and I briefly touched on this last night, and she equated it to the insurance company deciding not to pay for a mother electing to have a scheduled c-section because she could have had a vaginal birth. While it seems like they shouldn’t be able to decide these things, they do.
My husband found several forums where other people went through the appeals process and were successful in having their insurer pay for the TYPE of reconstruction they wanted versus the type that the plan allows, but it is a process that takes an investment of both time and energy. I also read that people have had success in doing this, but that they needed to start paying towards their bills from their providers and then seek reimbursement from their insurer.
I also found out that there are several things in the follow up stages that may not be covered by my insurance. Since my flaps are currently uneven, I would want to have a procedure to make them symmetrical. My insurance plan does not cover fat grafting, which would allow for my smaller flap to be made larger and the same size as the other by bringing fat from another site to the flap. Luckily, I am not interested in making the smaller one larger. I would like to actually have the larger one made smaller. But I don’t know if my plastic surgeon and I are on the same page, which we will discuss at my pre-op appointment. I have to go through my benefits booklet tonight to see if my scar revision is something that can also be disputed (for areas where there is fat puckering around it. These areas are truly very, very small. If it isn’t covered, I can live with my abdominal scar as-is.)
As of this time, I have received EOBs from my insurer refusing payment for my abdominal binder, surgical camisole, and my first physical therapy appointment. I have a lot of phone calls to make today!
While we haven’t received a formal letter of rejection from my insurance company yet, we’re preparing for it. But, I totally agree. We thought that under the WHCA, all reconstructions had to be covered. We’ll see when we get a letter from them.