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I need legal advise/help with breast surgery denial PLEASE HELP?


I am in Indianapolis, IN and I had a bilateral lumpectomy on my breasts in August of '04. One of the lumps that was removed from my right breast had a papilloma on it that was only TWO mutations away from cancer. How this all started was I had blood coming out of my right nipple.
In June of 2007, the same thing happened again. I had blood come out of my right nipple. I went back to my surgeon and she said the smartest thing to do was surgery again. I told her I was worried about deformity and symmetry. My right breast already has a dent in it from the first surgery.
She referred me to a plastic surgeon friend of hers and my insurance said no because he was out of network. They ended up approving it to the point of me getting a consultation with an in network plastic surgeon. Both doctors told me it was safer for me to have both surgeries at the same time and my ins. is stating they will not pay for it because it is not medically necessary. Does anyone know of any goodattorneys

They have denied it four times now. I just sent an email to my insurance telling them I was sick of playing their game and I had been more than patient concerning this matter, especially with what is at stake for me. Its like they are no even reading my notes. The kicker is my insurance is through who I work for which is a HOSPITAL!!!!!!
How ironic and scary is that?
Can anyone give me any suggestions or ideas? I am scared I sent that email because I don't know if the lady at my insurance will send it to my boss and they will make up some reason to fire me. I can not afford much- really anything- on an attorney but I feel this is totally unfair and they simply do not care about my health period. There is another woman who had a double masectomy at my work and has the same insurance co. and they are paying for her to have fat transferred from her stomach to reconstruct her breasts. How is that different from my case?
Any help would be greatly appreciated! Thank you!

You can always sue them later. First take care of yourself. Have you considered your alternatives? For example patient advocacy could help you significantly reduce your cost of breast surgery. Best program I know of for patient advocacy is MySimpleCard.

Heather, first, do not worry ahead for your job - you will attract what you are scarred for. Better talk to your boss and ask for help. Explain the situation and ask for an advise. Say that is not your fault that you are having this medical problem, but that you want to save your breasts - they will not regrow again just because of your insurance co. Do not tell your boss you are seeking a legal advise, ask for her or his help.
Unfortunately I can not help you with the information you are asking for - I live in Canada and I am fairly new to this continent - I came from Europe just a few years ago.
Good luck and let me know how the things are going. I can see your frustration and disappointment, but try to think positive and ask for help. Please do not forget to pray.

Mary-Yana

P.S. Thank you for adding me for your friend. M.

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