morning_dove1

As some of you know I'm trying to get my HMO to approve a pro mast. I've
been denied twice after letters were submitted to them from 2 of my
doctors. I'm not done yet, I still have the rights to appeals, but would
love to go in with some ammo so to speak...This is where I could use the
help. I saw my PS in Sept. and he was very honest with Gene and I about
the proceedures he could do. He told me based on what I've already had
done {mrm/immediate recon lat flap with saline implant} that I'd not
have "symmetry from day one" if I had "mastoplexy" surgery which is the
second option he gave me after mast and just saline implant. {he'll will
do either one}...but mastoplexy more then likely would require other
surgeries if I wanted to retain symmetry long term because it would age
with me. {loose weight gain weight etc} Obviously, if I'm going to have
this surgery, then it would be nice if I didn't have to have multiple
ones to keep this appearance.

I've researched the WHCRA {women's health and cancer rights act of 1998}
There's a section that speaks about recon if a women opts for recon
after mastectomy. It says that if the insurance carrier covers mast and
the women opts for recon afterwards they're responsible for paying for
this. It goes onto say they're also are obligated by this law to pay for
surgery/recon on the other breast to get "symmetry"
Okay....what I need to know is what _exactly_ {or close} do they mean
when they say "symmetry" The clause quoted is all it says...And I can't
find anywhere that breaks it down, and spells out what our right really
are regarding this type of situation.
The clause I'm questioning reads:
"Surgery and reconstruction of the other breast to produce a symmetrical
appearance"
The article that I read was found on "IVilliage" but I have found other
sites that carry basically the same information as this one, regarding
the text of the law.

I will only quote the first paragraph of this article. And this is
_only_ for the purpose to draw attention to a particular part of it that
seems to imply this law/coverage seems somewhat unlimited as far as what
they are talking about regarding "symmetry"

It says "During the final days of it's 1998 session, Congress passed a
massive budget bill to appropriate funds to nearly every component of
government. Included in this mammoth piece of legislation was the
Federal/mastectomy Women's Health and Cancer Rights Act of 1998 {WHCRA},
a pet project of former Senator Alfonse D'Amato {R-NY} The WHCRA,
effective for health plan years begining on or after October 21, 1998,
madates broad coverage for breast reconstruction and complications of
mastectomy surgery"
The term "broad" implies that whatever it takes to achieve symmetry
would be covered under this ruling/law.
Here is the url for IVillage, but not sure the page is still able to be
accessed as I saw this/printed on 8-15-03.
http:http://www.ivillagehealth.com/print/0,,172313,00.html
I typed "breast reconstruction" from my homepage search area {msntv}to
get this.
If you're able to acess the page that has the quoted paragraph that I
included here, the clauses I'm referring to would be listed as a, b, and
c. "b" is the one I'm asking about.
I also found articles on The American Cancer Society Website. This one
that I qouted was the only one that made reference to "broad coverage"
Thanks to all that have read this and thanks in advance to anyone that
can offer any help with this. I'd prefer to in guns loaded next time.
;-)
Take care there/God bless/Have a great weekend
annie

Ultimately.....we know deeply that the other side of every fear is a
freedom.

"Courage"...is *fear* that has said it's prayers.