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Breast Cancer Sucks, Love Amy: January 20, 2023: Into the insurance quagmire

Into the insurance quagmire

An exhausted end to a long week of phone calls.  By the end of the work week, I'd lost count of the number of phone calls that I'd made to various folks: my healthcare insurance company (several times), my plastic surgeon's insurance specialist (several times), my general surgeon's insurance specialist (several times), Care Counsel (several times, and once on conference with my insurance company).  It was frustrating.


The ongoing topic of discussion in my phone calls in these past two weeks was insurance coverage.  Was I getting it?  Was I gettin all of the procedures covered?  The general surgeon's office seemed very reassuring about my chances for getting insurance to pay for the bi-lateral mastectomy. And all the doctors that I'd consulted, from my oncologist, to two general surgeons, to the plastic surgeon all have recommended and saw as medically necessary a bilateral mastectomy, should I choose.  The plastic surgeon's office was not so sure that I would have any coverage at all.


Near mid-week I got a call from the general surgeon's office: my double mastectomy wouldn't need pre-authorization (which is insurance term meaning that the insurance company will cover both of my mastectomy procedures.).  I got a call from the plastic surgeon's office that informed me that I wouldn't need pre-authorization for a reconstruction on my cancer side, however with respect to the prophalactic side the insurance company would delay judgement until after the procedure.  So some good news, but not enough?  It was frustrating in light of the fact that I thought that the Women's Healthcare and Cancer Rights Act of 1998 alloted me coverage for reconstruction after both of my mastectomies.  


These procedures were expensive, afterall.


Near the end of Friday, I finally made a move that would ultimate yield a reward: calling the authorization department of my healthcare insurance company.  By talking with this department and giving them the CPT codes and diagnosis codes that were being used by my surgeons' offices, I was able to get them to open authorization case files.


The case file numbers, given to me by the insurance company, I was able to forward to my surgeons' offices.  This was like a case number and allowed the surgeons' offices to add clinical data to the case files to help forward my pre-authorization status.

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