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  • KT

Insurance Obstacles and the Surgery that Almost Didn't Happen

Updated: Nov 18, 2022

Being diagnosed with breast cancer is devastating enough but going through treatment while simultaneously navigating insurance coverage can be overwhelming. After enduring a double mastectomy surgery, expanders, and reconstruction, I sought a second opinion from a local plastic surgeon.

Most local plastic surgeons do not accept insurance or perform reconstruction surgery on breast cancer patients. I contacted my insurance company for a list of approved plastic surgeons and proceeded to call their offices. The nine names on the list actually consisted of only three group practices that participated in my plan. I had already seen a doctor in one of the practices, so I called the second practice. I was told that they did not accept my insurance plan. There were four names on the list from the insurance company in this practice. That left only one other practice, with four plastic surgeons. When I called for an appointment, I was told only one plastic surgeon would be available and accepting new patients. He was new to the practice and not yet board certified.

I contacted my insurance company and told them of my dilemma that several names on their list, including one my general surgeon had referred me to, did not participate with my insurance plan. She was not able to address my concerns, nor did she bother to forward this discovery to anyone who could update this list.

I did schedule another surgery before the end of the year yet struggled to get prior approval from the insurance company. When the office did not have approval two days before surgery, I contacted the insurance company directly and was told it was in the stack to be reviewed. I wasn’t willing to risk covering the cost of the surgery out-of-pocket and was stressed about whether the surgery would be postponed or actually take place as scheduled in two days.

The office called me the day prior to surgery to say they finally received approval from the insurance company. I received a letter in the mail approving the surgery three weeks after I had the procedure. Needless to say, the stress of dealing with breast cancer was compounded by the hurdles imposed by my insurance company.


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