Insurance Rejection

[Guest guest]

I just got final word from my insurance company that they will not pay

for the cosmetic surgery I had this past summer. I knew I was taking a

chance going in to this (they would not pre certify) and decided to go

ahead anyway. I am trying to decide whether to take this to the next

appeal level. It is a union policy, and would involve going before the

union trustees for an appeal. It is very awkward, as these trustees

work in my business, and I am worried about passing around graphic nude

before photos to people who I may some day come in contact with.

Emotionally, it may be better for me to work out a payment plan with the

surgeon, and try to pay off the bill over the next year.

But to compound matters, I've sent a letter to the surgeon, telling him

that I felt the paperwork was not handled properly from his end. I just

hung up from the woman in his office who handles claims, and she is

defensive and furious with me. (It's a long story, but vital paperwork

and photos were not sent initially, and would not have been sent had I

not noticed they were missing, etc.). To complicate matters, the

surgeon, (who I really love) did what was supposed to be a slight

revision three weeks ago and ended up pulling more skin than we

discussed, leaving me with deformed breasts that are really embarrassing

me.

I have an appointment with him tomorrow morning. He will have just

received my letter, and on top of that I'll have to tell him how unhappy

I am with my breasts. I've very nervous, and don't even know what a

solution is - do I live with the breasts as is, or do I have him do even

more work and try to fix them (either case makes me very unhappy). Do I

find a new surgeon? Will he refuse to do more work because I've

complained about the insurance? I've been thrilled with my tummy tuck,

and he did a fabulous job on my arms. But when he did the revision, he

really pulled too much skin from the breast, and they are now

practically touching with no space in-between. My bras don't fit, and

they look really weird.

I don't know if anyone has any experience with this kind of thing, but I

just needed to vent. I will bring my husband with my tomorrow, as I

really don't deal well with confrontations of any kind, let alone one

that affects my body like this.....I also feel weird about complaining

about the breasts, considering before the surgery, they were hanging to

my belly button and looked pretty horrible that way.

Helene

RNY 12/22/99

350/161