Four years, 8 months and 15 days ago at age 47 my life changed. I was diagnosed with breast cancer. This was not to happen to me. I was not 50 I had been doing things rights, had my mammograms starting at age 42, six months later and again in six months. At ages 43,44,45 once a year. At age 46 my physician said nothing had shown up or changed and since the American Cancer Society recommended mammograms every two years for women under 50, we skipped a year. The next year when I had my mammogram something was there to suggest a biopsy.
The day of my biopsies the diagnosis was cancer. The thought of cancer and being deformed for the rest of my life was not in my plans. I took steps to improve my life. I asked that both of my breasts be removed and that reconstructive surgery be done in one operation. I was not going to live with the constant reminder that cancer would rule my life. My surgeon, Dr. Gregory Eakins who removed my breast agreed that the best treatment was to elect to have both my breasts removed and reconstructive surgery. Since only one breast produced a cancerous tumor at the time of the biopsies Dr. Eakins said my insurance would not pay to remove or reconstruct the second breast.
At that time I did not care what my insurance would or would not pay. This is my life we were dealing with. Not a pile of papers, a stack of money or a financial report to stock holders. As I was being wheeled into the operating room a week later we still did not know what, if any my insurance would pay. Further testing of what was to be my healthy breast revealed it to be in a pre-cancerous condition. If I had not requested this extreme surgery I would be creating additional medical cost as the cancer would soon have returned.
With the help of my reconstructive surgeon Dr John Edney I requested that he use my own body tissue. Dr. Edney used my tummy fat and created new breasts for me, which are natural, my body did not reject the surgery nor do I live with the fear of additional health problems from a foreign object in my body. This surgery allows me to be a normal woman, easing the mental pain of breast cancer.
I am very fortunate that my insurance did pay for my surgery. I cannot understand why insurance companies feel they can dictate to us what can and cannot be covered under our health plans. We as insurance purchasers have a contract with them to receive the best in health care for the premiums we pay. The cost of my surgery has to be cost effective since it required only one surgery, one hospital stay. If I had accepted the notion that insurance would not pay for what I felt needed to be done, my health care cost would be much more than they are.
Constant mammograms, a second surgery, a second series of chemo-therapy, mental health care cost to deal with the unknown, rejection of an implant, or illness related to implants would have doubled my medical cost. Breast reconstruction is no different that any other prosthesis or organ transplant. This is why I believe insurance companies need to cover the cost of breast reconstruction. If they are concerned about cost effectiveness then they need to be paying for total breast reconstruction using the method selected by the patient and her doctor.
I completed 6 rounds of chemo-therapy after surgery and am in my fourth year of tamoxifen. I soon will be celebrating five years of new life. I strongly feel that my reconstructive surgery gave me more hope and encouragement than all the chemicals I have been treated with. A well mind is a healthy body.
I feel that if this diagnoses was handed to the wife, daughter or mother of an insurance executive then there would be proper coverage for breast cancer treatment, including the coverage of bone marrow transplants.
I know this is a lengthy letter but after reading the enclosed article in the Omaha World Herald I felt need to share my story with your organization. Someone must inform the Congress and insurance companies what is happening. Please forward this letter on if it would of help, or let me know who I should be writing to. I thank you for taking the time to read this letter. I wish your organization success.
Fran from Nebraska