Sunday, August 5, 2012

still awaiting news of surgeries......
This past week was non eventful except that I received the official Denial of Claims letter from Humana for both the breast cancer and the rib tumors. Now I  have begun the appeals process which is lengthy and complicated.

At first I didn't know if I could do the appeal on my own but am getting the swing of it after spending some time organizing the info this last week. I have flash backs to high school term paper torture. I then saw such a project as daunting but I'm really happy with what I've prepared so far. It is a multifaceted presentation to the adjusters to explain a very rare bone condition, show that it can grow for years but not be seen, asymptomatic, and that the fact that I did notice a rib on my right side was slightly larger than its counterpart 8 months ago was not a reason for a responsible adult to seek medical advice or treatment. Humana's definition of "pre-existing conditions" is so broad that just about anything that is slightly abnormal for 5 years prior to the policy effective date is considered pre-existing. It is a tough job ahead. To make it worse is that all the notes from doc appts and procedures and tests for both the breast cancer and bone tumors are all combined into same day and same notes so that the terminology is very difficult to determine when statements are referring to what conditions. Both conditions are in the chest area, both are described using words, as mass, lump, breast, etc. Because  Humana cannot see the two illnesses as unrelated––diagnosed/ discovered at the same time––then they are determining that both are pre-existing. I should be able to get coverage for the breast cancer but the rib tumors will be a much harder fight.

To date my obligation for medical expenses ( not covered by Humana ) is $43,659. What Humana has covered is $ 3,685. This is before any further surgeries! So my first priority is to write a really goooood term paper!  I'm thinking about including some self illustrated full color medical diagrams  to make myself understood. A bit much, I know.....

This Tuesday is the appointment with a Thoracic surgeon at Emory to get consult on the rib tumors. Thursday is an appointment with an accountant to help with a large IRS debt. Friday is an appointment with a plastic surgeon to discuss reconstruction options after mastectomy––either immediately or later––the timing will be partially determined by the thoracic surgeon's recommendations. And then next Monday I will have the appointment with my breast surgeon to hopefully schedule the double mastectomy that I have decided to go forward with.

for girls only.....
Breast cancer diagnosis: Infiltration ductal carcinoma. stage 1( left ), lymph nodes clear. ER positive. PR: Negative. Ki-67: 7%. EIC positive. Neg IHC.  pT1c / pNO (i-). EIC positive

I'm still trying to interpret these pathology report findings but prognosis is good. The EIC positive finding indicates a greater risk for recurrence of cancer in the same breast. This was one of the factors in my choosing the mastectomy over repeated lumpectomies and radiation.

Check out the blog list in the side column if you would like to see first hand stories and pictures of breast reconstruction. It's an education! I'll need to be brave. Don't expect me to be including any pictures of my process but these brave ladies have given those of us facing this surgery a first hand look into what to expect. I applaud them for sharing such a private part of their journey for the benefit of us facing it. It helps to know what to expect.