Guest guest Posted February 11, 2003 Report Share Posted February 11, 2003 Hi Zach, Well as I'm sure you know I'm now 41 years old and recently finished my reconstruction for unilateral(right side)microtia. During the course of my surgeries my husbands company changed insurance. Well, the first insurance company we had covered everything no questions. The second insurance company has covered all the surgeries as well with no hassle or questions. I know insurance companies are more willing to cover reconstructive surgeries more so then cosmetic surgeries. Also, I think if the surgeon you choose writes a letter of preapproval that is well worded and convincing of the need for the surgery it weighs alot in your favor. Like I said earlier, I can't offer much more advice because (knock on wood) my insurance companies(well the 2 that we've had) have covered everything with no hassle at all. Patton Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2003 Report Share Posted February 11, 2003 Zach, In regards to the ear (although I have not seen it), I can make two comments. 1) If there is too much scar tissue for an autogenous reconstruction, then there is no way that a synthetic implant is going to work. 2) If Dr. Brent doesn't want to touch it, there is probably a good reason. I would work on the mandible and cheekbone for now. Dr Eppley -----Original Message----- Sent: Monday, February 10, 2003 10:45 PMTo: AtresiaMicrotia Subject: Insurance questionHey all! I don't know most of you really but I do read this group and am so glad something like this is available for people. Anyway, I'm a 24 y/o male blah blah blah with L-side HFM/Microtia. I had several operations as a youngon' that left me with extremely undesirable results. I've seen Dr. Brent twice (most recently about two years ago) and he doesn't want to touch my ear as there is too much scar tissue, not enough viable tissue I guess. I need to have my mandible lengthened and possibly zygomatic bone, and then I have to see what I want to do about my ear. I could try to see if Dr. Nagata could do a secondary reconstruction to my satisfaction, but it may be that a prosthetic would be the best option for me. Any thoughts? I have been on my parents' insurance up till now and it will run out when I turn 25 in March. I graduate college in June and will have a good-paying, benefited job around that time. The problem is, will a new insurance company have problems with paying for my reconstructive (not cosmetic) surgery? For instance, if I get a job and I get this "good" benefit package, will they freak out if I all of the sudden inform them of my surgery plans? I know there are some bad insurance companies that I hopefully will stay away from. My view is that no matter what age I decide to have work done, the insurance company I'm with at that time should help a considerable amount since it is 'reconstructive' in nature. Your thoughts are appreciated.Zach Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2003 Report Share Posted February 11, 2003 > In regards to the ear (although I have not seen it), I can make two comments. > > 1) If there is too much scar tissue for an autogenous reconstruction, then there is no way > that a synthetic implant is going to work. > > 2) If Dr. Brent doesn't want to touch it, there is probably a good reason. Dr. Eppley, I know that Dr. Brent is the best and I understand that since they tried to reconstruct my ear here many years ago, my options are much more limited now. I don't understand why you think a prosthetic ear wouldn't work? It's not live tissue. Please explain. Thank you. Zach Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2003 Report Share Posted February 11, 2003 Zach, Are you referring to a prosthetic ear framework over which the existing scarred skin kmust cover or scraping the existing reconstruction and going with an implant-based prosthetic ear? A prosthetic ear framework will quickly become exposed or extrude due to your scarred skin. However, an external prosthesis would, of course, work because it is external not internal. Dr Eppley Re: Insurance question > In regards to the ear (although I have not seen it), I can make two comments. > > 1) If there is too much scar tissue for an autogenous reconstruction, then there is no way > that a synthetic implant is going to work. > > 2) If Dr. Brent doesn't want to touch it, there is probably a good reason. Dr. Eppley, I know that Dr. Brent is the best and I understand that since they tried to reconstruct my ear here many years ago, my options are much more limited now. I don't understand why you think a prosthetic ear wouldn't work? It's not live tissue. Please explain. Thank you. Zach Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2003 Report Share Posted February 11, 2003 > Zach, > > Are you referring to a prosthetic ear framework over which the existing scarred skin kmust cover or scraping the existing reconstruction and going with an implant-based prosthetic ear? > > A prosthetic ear framework will quickly become exposed or extrude due to your scarred skin. However, an external prosthesis would, of course, work because it is external not internal. > > Dr Eppley > Dr. Eppley, I was referring to the latter, that's why your other reply confused me. The prosthetic ear framework with skin, is that that polyethylene implant that some folks have talked about? Some of the tissue may still be viable, but I think it may be best to just remove what I have and go with the external prosthetic. Zach Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2003 Report Share Posted February 11, 2003 Hi Zach! As you can tell, we are soooooo blessed to have Sheri as the " Group Insurance Expert. " Like Sheri advised, if you can tie your surgical procedures to your microtia and/or HFM, then you have a better shot at obtaining coverage because they were conditions present at birth, rather than a cosmetic procedure. Anytime you can get a statement from your physician explaining the medical necessity for the procedure, and submit it with the claim for authorization, it can help to avoid the perception of " cosmetic surgery " and eliminate or lessen that circus act. Seems to me most of the denials we received were from insurance employees who had no idea what microtia, atresia, or HFM were and simply lumped them into the cosmetic category. Once we sent them letters and had our physicians backing us up, they came around. Do you know where you'll be working when you graduate? If you do, you can begin to get some background info regarding the options available to you and run them past the group to see if we have any experience with specific insurance company(ies). Hope this is helpful! Peace, beth > " zachinmexico@...> >Reply-To: AtresiaMicrotia >To: AtresiaMicrotia >Subject: Insurance question >Date: Tue, 11 Feb 2003 03:45:11 -0000 > >Hey all! > > I don't know most of you really but I do read this group and am so >glad something like this is available for people. > Anyway, I'm a 24 y/o male blah blah blah with L-side >HFM/Microtia. I had several operations as a youngon' that left me >with extremely undesirable results. I've seen Dr. Brent twice (most >recently about two years ago) and he doesn't want to touch my ear as >there is too much scar tissue, not enough viable tissue I guess. > I need to have my mandible lengthened and possibly zygomatic bone, >and then I have to see what I want to do about my ear. I could try >to see if Dr. Nagata could do a secondary reconstruction to my >satisfaction, but it may be that a prosthetic would be the best >option for me. Any thoughts? > I have been on my parents' insurance up till now and it will run >out when I turn 25 in March. I graduate college in June and will >have a good-paying, benefited job around that time. The problem is, >will a new insurance company have problems with paying for my >reconstructive (not cosmetic) surgery? For instance, if I get a job >and I get this " good " benefit package, will they freak out if I all >of the sudden inform them of my surgery plans? I know there are some >bad insurance companies that I hopefully will stay away from. My >view is that no matter what age I decide to have work done, the >insurance company I'm with at that time should help a considerable >amount since it is 'reconstructive' in nature. > Your thoughts are appreciated. > >Zach > _________________________________________________________________ MSN 8 with e-mail virus protection service: 2 months FREE* http://join.msn.com/?page=features/virus Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2003 Report Share Posted February 11, 2003 beth, Very good to meet you. Yes Sheri was a wealth of information. I'm so glad to have run across you guys here. Now that I'm getting into all of this, the support is really important. Growing up I've only met a couple people with microtia/HFM issues and these were one- time meetings. Reading all these posts from people with craniofacial issues or their parents drives home to me that there are others like me! I know I'm 24 and I should have learned that a long time ago, but sometimes you get wrapped up in life and then when it hits you, you realize you never dealt with the situation. That time is now and I'm here. Zach > > Do you know where you'll be working when you graduate? If you do, you can > begin to get some background info regarding the options available to you > and run them past the group to see if we have any experience with specific > insurance company(ies). Hope this is helpful! Peace, beth Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2003 Report Share Posted February 12, 2003 Zach, That would be the appropriate way to go. Dr Eppley -----Original Message----- Sent: Tuesday, February 11, 2003 9:13 PMTo: AtresiaMicrotia Subject: Re: Insurance question> Zach,> > Are you referring to a prosthetic ear framework over which the existing scarred skin kmust cover or scraping the existing reconstruction and going with an implant-based prosthetic ear?> > A prosthetic ear framework will quickly become exposed or extrude due to your scarred skin. However, an external prosthesis would, of course, work because it is external not internal.> > Dr Eppley> Dr. Eppley, I was referring to the latter, that's why your other reply confused me. The prosthetic ear framework with skin, is that that polyethylene implant that some folks have talked about? Some of the tissue may still be viable, but I think it may be best to just remove what I have and go with the external prosthetic.Zach Quote Link to comment Share on other sites More sharing options...
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