Re: Re: AETNA AND EXPLANT POLICY

[Guest guest]

How interesting! I wonder if Kathie's explant could be covered because it

is related to implants inserted following a mastectomy.

Kenda

> Isn't it interesting how some insurance companies will drop people if

> they find out about implants - but yet the FDA calls them " safe " .

> The insurance companies have obviously had to deal with many women

> are are ill because of implants. I called my insurance company

> without giving a name, and they said the only way an explant was

> covered was if I got the implants because of cancer.

>

>

>>>

>>> hi....on advice of this support system, i called aetna to see if

>> they

>>> would cover explant....their document, from march, 2005, is quite

>>> extensive in its explaining of coverage....at any rate, the parts

>>> covering " silicone " related illness makes it almost impossible to

>>> have it covered that way...however, if i find the right doctor

>> (still

>>> searching, needing an angel!) and they BILL correctly (read: not

> a

>>> word about silicone) then the surgery, any and all complications,

>>> would be covered....of course the doc has to be in

>>> network.....anyway, i feel fairly guilty ignoring the silicone

>> part

>>> and playing the game....on the other hand, i want to die some

>> days,

>>> and so, i feel like perhaps it is okay to play the

>>> game...........what do you all think? am i a seel-out if i find

>> help

>>> this way? the neuropathy, the movement of the implant, which is

>> now

>>> preventing me from washing my own hair, driving, wiping off a

>>> counter, plus the pure PAIN, which may be post mastectomy pain

>>> syndrome (which is probably silicone related!) is just way too

>>> much....i am about to lose my job for crying every

>> day.......thanks

>>> for listening............

>>>

>>> blessings,

>>>

>>> kathie

>>>

>>

>

>

>

>

>

>

> Opinions expressed are NOT meant to take the place of advice given by licensed

> health care professionals. Consult your physician or licensed health care

> professional before commencing any medical treatment.

>

> " Do not let either the medical authorities or the politicians mislead you.

> Find out what the facts are, and make your own decisions about how to live a

> happy life and how to work for a better world. " - Linus ing, two-time

> Nobel Prize Winner (1954, Chemistry; 1963, Peace)

>

> See our photos website! Enter " implants " for access at this link:

> http://.shutterfly.com/action/

>

>

[Guest guest]

Perhaps they accept the premise of infection caused by

contaminated implants.

Surely they know that it's going to cost them a lot of

money for you to stay sick!

Hugs,

Rogene

[Guest guest]

This makes me wonder what Aetna would do if a man

started having problems after getting a penile

implant?

Wanna bet he would be covered?

Rogene

[Guest guest]

Is he willing to do the surgery if you pay upfront and then prepare the

necessary information for you to send the bill to your own insurance company

for reimbursement? That may be the way to go.

Kenda

> hi...thanks for your response...i am curious, i have contacted

> hiatt's office, and they were 1. rude, and 2. said he takes NO

> insurance.... i will never understand how a doc makes a living

> taking NO INSURANCE! wish he did, i know he is the only doc listed

> in AZ with experience explanting...........sooo, i carry on with this

> battle, and am trying to find a doc who will bill with the right

> code...........

>

> blessings,

>

> kathie

>

>

>>>

>>> hi....on advice of this support system, i called aetna to see if

>> they

>>> would cover explant....their document, from march, 2005, is quite

>>> extensive in its explaining of coverage....at any rate, the parts

>>> covering " silicone " related illness makes it almost impossible to

>>> have it covered that way...however, if i find the right doctor

>> (still

>>> searching, needing an angel!) and they BILL correctly (read: not

> a

>>> word about silicone) then the surgery, any and all complications,

>>> would be covered....of course the doc has to be in

>>> network.....anyway, i feel fairly guilty ignoring the silicone

>> part

>>> and playing the game....on the other hand, i want to die some

>> days,

>>> and so, i feel like perhaps it is okay to play the

>>> game...........what do you all think? am i a seel-out if i find

>> help

>>> this way? the neuropathy, the movement of the implant, which is

>> now

>>> preventing me from washing my own hair, driving, wiping off a

>>> counter, plus the pure PAIN, which may be post mastectomy pain

>>> syndrome (which is probably silicone related!) is just way too

>>> much....i am about to lose my job for crying every

>> day.......thanks

>>> for listening............

>>>

>>> blessings,

>>>

>>> kathie

>>>

>>

>

>

>

>

>

>

> Opinions expressed are NOT meant to take the place of advice given by licensed

> health care professionals. Consult your physician or licensed health care

> professional before commencing any medical treatment.

>

> " Do not let either the medical authorities or the politicians mislead you.

> Find out what the facts are, and make your own decisions about how to live a

> happy life and how to work for a better world. " - Linus ing, two-time

> Nobel Prize Winner (1954, Chemistry; 1963, Peace)

>

> See our photos website! Enter " implants " for access at this link:

> http://.shutterfly.com/action/

>

>

[Guest guest]

Ok, then it isn't silicone illness, it's something else and still needs to

be dealt with

Kenda

> well mine ARE from having cancer, and immediate reconstruction, but

> aetna STILL wants a diagnosis of some kind to cover removal AND has a

> LOOOONNNGGGG clause saying " silicone illness " doesn't exist and is

> NOT a billable concern when covering explant procedures! sigh........

>

> blessings,

>

> kathie

>

>

>>>>

>>>> hi....on advice of this support system, i called aetna to see

> if

>>> they

>>>> would cover explant....their document, from march, 2005, is

> quite

>>>> extensive in its explaining of coverage....at any rate, the

> parts

>>>> covering " silicone " related illness makes it almost impossible

> to

>>>> have it covered that way...however, if i find the right doctor

>>> (still

>>>> searching, needing an angel!) and they BILL correctly (read:

> not

>> a

>>>> word about silicone) then the surgery, any and all

> complications,

>>>> would be covered....of course the doc has to be in

>>>> network.....anyway, i feel fairly guilty ignoring the silicone

>>> part

>>>> and playing the game....on the other hand, i want to die some

>>> days,

>>>> and so, i feel like perhaps it is okay to play the

>>>> game...........what do you all think? am i a seel-out if i

> find

>>> help

>>>> this way? the neuropathy, the movement of the implant, which

> is

>>> now

>>>> preventing me from washing my own hair, driving, wiping off a

>>>> counter, plus the pure PAIN, which may be post mastectomy pain

>>>> syndrome (which is probably silicone related!) is just way too

>>>> much....i am about to lose my job for crying every

>>> day.......thanks

>>>> for listening............

>>>>

>>>> blessings,

>>>>

>>>> kathie

>>>>

>>>

>>

>

>

>

>

>

>

> Opinions expressed are NOT meant to take the place of advice given by licensed

> health care professionals. Consult your physician or licensed health care

> professional before commencing any medical treatment.

>

> " Do not let either the medical authorities or the politicians mislead you.

> Find out what the facts are, and make your own decisions about how to live a

> happy life and how to work for a better world. " - Linus ing, two-time

> Nobel Prize Winner (1954, Chemistry; 1963, Peace)

>

> See our photos website! Enter " implants " for access at this link:

> http://.shutterfly.com/action/

>

>

[Guest guest]

Kathie,

How about under the cancer portion of your policy? I would assume that

Aetna paid for the implants and reconstruction of your breasts. Perhaps you

could claim that the job was botched and that is what is making you sick?

Has it been ruled out that the implants are leaking?

Kenda

> keep in mind, my understanding is that even though at first it looks

> like " cancer " is the key component (on page 1) and that i would be

> covered, the second lady i talked to and read this with over the

> phone, pointed out the billing/diagnosis codes that i have to have,

> though as rogene pointed out, the right PS will know how to play the

> game......anyway, here is the document link.....pay attention to how

> the hadle the silicone/saline/autoimmune issue....the link:

>

> http://www.aetna.com/cpb/data/CPBA0142.html

>

> kathie

>

>

>

>>>>>>>

>>>>>>> hi....on advice of this support system, i called aetna to

>> see if

>>>>>> they

>>>>>>> would cover explant....their document, from march, 2005, is

>>> quite

>>>>>>> extensive in its explaining of coverage....at any rate, the

>>> parts

>>>>>>> covering " silicone " related illness makes it almost

>> impossible

>>> to

>>>>>>> have it covered that way...however, if i find the right

>> doctor

>>>>>> (still

>>>>>>> searching, needing an angel!) and they BILL correctly

> (read:

>> not

>>>>> a

>>>>>>> word about silicone) then the surgery, any and all

>>> complications,

>>>>>>> would be covered....of course the doc has to be in

>>>>>>> network.....anyway, i feel fairly guilty ignoring the

>> silicone

>>>>>> part

>>>>>>> and playing the game....on the other hand, i want to die

> some

>>>>>> days,

>>>>>>> and so, i feel like perhaps it is okay to play the

>>>>>>> game...........what do you all think? am i a seel-out if i

>> find

>>>>>> help

>>>>>>> this way? the neuropathy, the movement of the implant,

>> which is

>>>>>> now

>>>>>>> preventing me from washing my own hair, driving, wiping off

> a

>>>>>>> counter, plus the pure PAIN, which may be post mastectomy

>> pain

>>>>>>> syndrome (which is probably silicone related!) is just way

>> too

>>>>>>> much....i am about to lose my job for crying every

>>>>>> day.......thanks

>>>>>>> for listening............

>>>>>>>

>>>>>>> blessings,

>>>>>>>

>>>>>>> kathie

>>>>>>>

>>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>> Opinions expressed are NOT meant to take the place of advice

>>> given by licensed

>>>>> health care professionals. Consult your physician or licensed

>>> health care

>>>>> professional before commencing any medical treatment.

>>>>>

>>>>> " Do not let either the medical authorities or the politicians

>>> mislead you.

>>>>> Find out what the facts are, and make your own decisions

> about

>>> how to live a

>>>>> happy life and how to work for a better world. " - Linus

>> ing,

>>> two-time

>>>>> Nobel Prize Winner (1954, Chemistry; 1963, Peace)

>>>>>

>>>>> See our photos website! Enter " implants " for access at this

>> link:

>>>>> http://.shutterfly.com/action/

>>>>>

>>>>>

[Guest guest]

I would have an attorney read your policy. My reading of it made me think

you are covered under the cancer portion. I wouldn't want to deceive the

insurance company only because they can come back at you but it sure seems

like you ought to be covered without jumping through hoops. I can see why

the insurance company wouldn't want to have to cover surgery to replace

implants from all women who need new implants but to turn down a cancer

victim seems quite unfair. It certainly wasn't a surgery that you chose to

have to begin with.

Kenda

> i know, the first lady and i thought we had it covered with

> the " cancer " part, but then the second lady read it with me and said

> i STILL had to have a " diagnosis " ....actually, i had cigna at the

> time of my mastectomy...when my district changed insurance companies

> three years ago, aetna had to accept me.....so they do have to cover

> me, if i play the game....i am busily working on that and i so

> appreciate all the women who have offered advice and support

> here.....thank you...oh, and yes, i had a breast coil MRI six weeks

> ago, and they were not leaking then....the radiologist even did a

> follow-up ultrasound.....i know silicone leaks, even when they look

> intact, and i do so much want them gone....i feel a little hopeful,

> even through my pain, that i will find a way now.........

>

> blessings,

>

> kathie

>

>

>

>>>>>>>>>

>>>>>>>>> hi....on advice of this support system, i called aetna to

>>>> see if

>>>>>>>> they

>>>>>>>>> would cover explant....their document, from march, 2005, is

>>>>> quite

>>>>>>>>> extensive in its explaining of coverage....at any rate, the

>>>>> parts

>>>>>>>>> covering " silicone " related illness makes it almost

>>>> impossible

>>>>> to

>>>>>>>>> have it covered that way...however, if i find the right

>>>> doctor

>>>>>>>> (still

>>>>>>>>> searching, needing an angel!) and they BILL correctly

>>> (read:

>>>> not

>>>>>>> a

>>>>>>>>> word about silicone) then the surgery, any and all

>>>>> complications,

>>>>>>>>> would be covered....of course the doc has to be in

>>>>>>>>> network.....anyway, i feel fairly guilty ignoring the

>>>> silicone

>>>>>>>> part

>>>>>>>>> and playing the game....on the other hand, i want to die

>>> some

>>>>>>>> days,

>>>>>>>>> and so, i feel like perhaps it is okay to play the

>>>>>>>>> game...........what do you all think? am i a seel-out if i

>>>> find

>>>>>>>> help

>>>>>>>>> this way? the neuropathy, the movement of the implant,

>>>> which is

>>>>>>>> now

>>>>>>>>> preventing me from washing my own hair, driving, wiping off

>>> a

>>>>>>>>> counter, plus the pure PAIN, which may be post mastectomy

>>>> pain

>>>>>>>>> syndrome (which is probably silicone related!) is just way

>>>> too

>>>>>>>>> much....i am about to lose my job for crying every

>>>>>>>> day.......thanks

>>>>>>>>> for listening............

>>>>>>>>>

>>>>>>>>> blessings,

>>>>>>>>>

>>>>>>>>> kathie

>>>>>>>>>

>>>>>>>>

>>>>>>>

>>>>>>>

>>>>>>>

>>>>>>>

>>>>>>>

>>>>>>>

>>>>>>> Opinions expressed are NOT meant to take the place of advice

>>>>> given by licensed

>>>>>>> health care professionals. Consult your physician or licensed

>>>>> health care

>>>>>>> professional before commencing any medical treatment.

>>>>>>>

>>>>>>> " Do not let either the medical authorities or the politicians

>>>>> mislead you.

>>>>>>> Find out what the facts are, and make your own decisions

>>> about

>>>>> how to live a

>>>>>>> happy life and how to work for a better world. " - Linus

>>>> ing,

>>>>> two-time

>>>>>>> Nobel Prize Winner (1954, Chemistry; 1963, Peace)

>>>>>>>

>>>>>>> See our photos website! Enter " implants " for access at this

>>>> link:

>>>>>>> http://.shutterfly.com/action/

>>>>>>>

>>>>>>>