Fw: Medicare regulation 42 CFR 422.101

[Guest guest]

From: " Deb Bjornson (by way of ilena rose) " <wwjddeb_99@...>

Sent: Saturday, September 22, 2001 7:47 PM

Subject: Medicare regulation 42 CFR 422.101

> I give God all praise honor and glory for the overturn

> of my HMO's denial for a referral to see a plastic

> surgeon.

>

> The Medicare regulation in the subject line states

> that M+CO's MUST provide coverage of ALL services that

> are covered by Part A and Part B of Medicare.

>

> When my HMO denied this referral based on my MRI

> report showing no sign of rupture... I was frustrated,

> angered and more determand than ever to fight them

> with Gods help and win!

>

> I prayed, I sent you all emails asking if anyone had

> normal MRI's and found out on explantation that their

> implants were indeed ruptured. I got a great response

> from so many of you precious ones... Thank you!

>

> This is what (CHDR) The Center for Health Dispute

> Resolution had to say :

> Upon careful review of all avaiable case file

> infromation, (many of your letters) CHDR finds that

> you do meet the Medicare criteria for coverage of the

> above named referral. Records indicate that you are

> rrequestion covage of a consultation with Dr.

> , a plastic surgeon for an evaluation of

> chronic breast pain with potential breast implant

> leakage. The record indicates that Dr. is a

> participating provider with the M+CO. The medical

> specialist noted that the MRI performed on 7/27/01

> showed bilateral subglandural breast implants that

> appear intact with no evidence of implant rupture.

> The medical speicalist noted IT IS POSSIBLE THAT THE

> IMPLANTS MAY HAVE A CONTAINED RUPTURE AND STILL SHOW

> NORMAL ON MAMMOGRAM, The specialist further noted THAT

> AT TIMES NOT ALL RUPTURED IMPLANTS SHOW CLEAR EVIDENCE

> OF RUPTUREE PRE-OPERATIVELY. The medical specialist

> DETERMINED THAT IT IS MEDICALLY NECESSARY FOR " ME "

> TO BE EVALUATED BY A PLASTIC SURGEON TO EVALUATE THE

> STATUS OF THE BREAST IMPLANTS. IF THE PLASTIC SURGEON

> FINDS THE EVIDENC ON PHYSICAL EXAMINATION THAT THE

> IMPLANTS WERE RUPTURED, THEN THE IMPLANTS SHOULD BE

> REMOVED. CONSEQUENTLY, CHDR FINDS THAT THE REFERRAL

> TO DR. WILLIAMS FOR EVAULATION OF CHRONIC BREAST PAIN

> WITH POTENTIAL BREAST IMPLANT LEAKAGE IS MEDICALLY

> NECESSARY FOR " ME "

>

>

> THERE FOR CHDR HAS DETERMINED THAT THE M+CO IS

> REQUIRED TO AUTHORIZE OR PAY FOR THE REFERRAL TO DR.

> WILLIAMS FOR " ME " AS REQUESTED BY DR. ELLIS.

>

> THIS DETERMIATION IS FINAL AND BINDING UNLESS THERE IS

> CAUSE FOR REPPENING THIS CASE UNDER SECTIONS 405.750

> AND 422.616 OF TITLE 42 OF THE CODE OF FEDERAL

> REGULATIONS.

>

> Precious ones, I have been able to express a greenish

> clear, sticky fluid from my nipples for 20 years now.

> In the past this fluid has been marbled with blood!

> 20-TWENTY YEARS!!!!!!!!!!!!!!!! I have been implanted

> 22-TWENTY-TWO YEARS!!!!!!!!!!!!

>

> I have saline filled implants... I will let you all

> know when I'm going under the knife. In 1991 I was

> stepped on by a 1500 pound rodeo bull (I use to ride

> them) I crushed 4-posterior ribs right behind my

> R-breast. In 1999 I was involved in a 60 MPH accident

> when my pre 1995 higher volocity airbag deployed.

> Both of this horrible traumas left my right breast the

> color of an eggplant for 2+months!!!!!! Do you think

> that I " may " have a rupture???????? HA!!!!!!! If

> that is not enough my right breast is flat and it

> rolls under my arm pit when I lay on my back!!!!!!

>

> Do you think that after all of these years....... a

> doctor will admit that I have a rupture?

>

> I hope that this info can be helpful for others

> fighting their insurance companies!

>

> THANK YOU GOD... AND THANK YOU PRECIOUS ONES!

> Deb

>

>

>

>

> =====

> Patsy Clairmont.... from " Under His Wings and Other Places of

> Refuge " ... " Healing is a risk because to be healed, we must trust " ....

> Surely God is my salvation; I will trust and not be afraid. The Lord, the

> Lord, is my strength and my song; He has become my salvation. Isaiah 12:2

> (NIV)

>

>

>